210405 COIMISIUN FIOSRU CHAIN UM EASLAINTE MEABHRACH (Commission of Inquiry on Mental Illness) 1966 TUARASCAIL (Report) DUBLIN: PUBLISHED BY THE STATIONERY OFFICE. To be purchased from the GOVERNMENT PUBLICATIONS SALE OFFICE G.P.O. ARCADE, DUBLIN, or through any Bookseller. Price: Seven shillings and sixpence. (Pr. 9181) 210405 COIMISIUN FIOSRU CHAIN UM EASLAINTE MEABHRACH (Commission of Inquiry on Mental Illness) 1966 TUARASCAIL (Report) DUBLIN: PUBLISHED BY THE STATIONERY OFFICE. To be purchased from the GOVERNMENT PUBLICATIONS SALE OFFICE G.P.O. ARCADE, DUBLIN, or through any Bookseller. Price: Seven shillings and sixpence. (Pr. 9181) The cost of preparing this Report, which was presented to the Minister for Health on 11th November, 1966, is estimated at ?14,760 of which ?1,600 is the estimated cost of printing and publication. The cost of preparing this Report, which was presented to the Minister for Health on 11th November, 1966, is estimated at ?14,760 of which ?1,600 is the estimated cost of printing and publication. CONTENTS SUMMARY (A) (B) GENERAL DETAILED STATEMENT OF COMMISSION'S RECOMMENDATIONS (1) (2) (3) (4) (5) (6) (7) In-Patient Care Community Services Provision for Special Classes Prevention and Research Education and Training Organisation of Services Legislation Page xiii xvii xvii xxii xxiii xxx xxxi xxxvi xxxviii ... REPORT PRELIMINARY Paragraph 1 Terms of Reference ... 2 Membership 3 Procedure 4 Acknowledgments 5 Arrangement of Report xli xli xli xlii xliii PART I INTRODUCTION CHAPTER 1 HISTORICAL 6 7 8 9 10 Development of Public Asylums Development of Private Asylums and Homes Prevalence of Mental Illness Committees and Commissions Legislation in ... 3 4 4 5 8 CONTENTS SUMMARY (A) (B) GENERAL DETAILED STATEMENT OF COMMISSION'S RECOMMENDATIONS (1) (2) (3) (4) (5) (6) (7) In-Patient Care Community Services Provision for Special Classes Prevention and Research Education and Training Organisation of Services Legislation Page xiii xvii xvii xxii xxiii xxx xxxi xxxvi xxxviii ... REPORT PRELIMINARY Paragraph 1 Terms of Reference ... 2 Membership 3 Procedure 4 Acknowledgments 5 Arrangement of Report xli xli xli xlii xliii PART I INTRODUCTION CHAPTER 1 HISTORICAL 6 7 8 9 10 Development of Public Asylums Development of Private Asylums and Homes Prevalence of Mental Illness Committees and Commissions Legislation in ... 3 4 4 5 8 IV CHAPTER 2 TRENDS IN THE CARE OF THE MENTALLY I I I Paragraph 11 Ancient Times 12 Change of Attitude 13 Concepts of Pinel and Others 14 Decline of "Moral" Treatment 15 Further Change in Attitude 16 Emphasis on Community Services 17 Expansion of Scope of Psychiatry 18 Integration of Psychiatry and General Medicine . 19 Reduction in the Number of In-patients 20 Appreciation of Need for Improved Services Page 11 11 12 13 13 14 15 16 16 18 PART H PSYCHIATRIC SERVICES IN IRELAND CHAPTER 3 PATTERN OF EXISTING SERVICES 21 22 23 24 25 26 27 28 29 30 General Services by Health Authorities Accommodation and Facilities in District Mental Hospitals Out-patient Services Health Authority Staff Services by Private Mental Hospitals and Homes ... Accommodation and Facilities in Private Mental Hospitals and Homes Staff in Private Mental Hospitals and Homes Services by Voluntary Hospitals Numbers of In-patients 21 21 21 22 22 23 23 23 23 24 PART HI RECOMMENDATIONS FOR THE IMPROVEMENT AND EXPANSION OF PSYCHIATRIC SERVICES CHAPTER 4 IN-PATIENT CARE 31 General ... 29 IV CHAPTER 2 TRENDS IN THE CARE OF THE MENTALLY I I I Paragraph 11 Ancient Times 12 Change of Attitude 13 Concepts of Pinel and Others 14 Decline of "Moral" Treatment 15 Further Change in Attitude 16 Emphasis on Community Services 17 Expansion of Scope of Psychiatry 18 Integration of Psychiatry and General Medicine . 19 Reduction in the Number of In-patients 20 Appreciation of Need for Improved Services Page 11 11 12 13 13 14 15 16 16 18 PART H PSYCHIATRIC SERVICES IN IRELAND CHAPTER 3 PATTERN OF EXISTING SERVICES 21 22 23 24 25 26 27 28 29 30 General Services by Health Authorities Accommodation and Facilities in District Mental Hospitals Out-patient Services Health Authority Staff Services by Private Mental Hospitals and Homes ... Accommodation and Facilities in Private Mental Hospitals and Homes Staff in Private Mental Hospitals and Homes Services by Voluntary Hospitals Numbers of In-patients 21 21 21 22 22 23 23 23 23 24 PART HI RECOMMENDATIONS FOR THE IMPROVEMENT AND EXPANSION OF PSYCHIATRIC SERVICES CHAPTER 4 IN-PATIENT CARE 31 General ... 29 V (a) Short-term Care Paragraph 32 Concept of Psychiatric Units in, or associated with, General Hospitals 33 Methods of Providing Short-term Psychiatric Units in, or associated with, General Hospitals 34 Form of Short-term Psychiatric Units in, or associated with, General Hospitals 35 Arguments for Short-term Psychiatric Units in, or associated with, General Hospitals 36 Arguments against Short-term Psychiatric Units in, or associated with, General Hospitals 37 Commission's Conclusions 38 Need for Integration 39 Types of Patients 40 Accommodation and Facilities Required 41 Association of Staff with other Forms of Psychiatric Care 42 Staffing 43-49 Provision of Short-term Psychiatric Units (b) Long-term Care 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 General Staffing Activity Occupational Therapy Recreation Purpose of Work Range of Suitable Work Activity Industrial Therapy Educational Content Payment for Work Sheltered Employment Placement Services Physical Environment Preservation of the Individuality of the Patient Liaison with Short-term Units Liaison with the Public Number of Long-term Patients Use of District Mental Hospitals (c) The Role of Private Mental Hospitals and Homes 68 69 70 71 General Classification Private Psychiatric Hospitals Psychiatric Nursing Homes Page 29 30 30 31 32 33 34 34 34 35 36 36 40 41 41 42 42 43 44 44 45 46 46 47 47 48 49 49 49 50 53 53 54 54 V (a) Short-term Care Paragraph 32 Concept of Psychiatric Units in, or associated with, General Hospitals 33 Methods of Providing Short-term Psychiatric Units in, or associated with, General Hospitals 34 Form of Short-term Psychiatric Units in, or associated with, General Hospitals 35 Arguments for Short-term Psychiatric Units in, or associated with, General Hospitals 36 Arguments against Short-term Psychiatric Units in, or associated with, General Hospitals 37 Commission's Conclusions 38 Need for Integration 39 Types of Patients 40 Accommodation and Facilities Required 41 Association of Staff with other Forms of Psychiatric Care 42 Staffing 43-49 Provision of Short-term Psychiatric Units (b) Long-term Care 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 General Staffing Activity Occupational Therapy Recreation Purpose of Work Range of Suitable Work Activity Industrial Therapy Educational Content Payment for Work Sheltered Employment Placement Services Physical Environment Preservation of the Individuality of the Patient Liaison with Short-term Units Liaison with the Public Number of Long-term Patients Use of District Mental Hospitals (c) The Role of Private Mental Hospitals and Homes 68 69 70 71 General Classification Private Psychiatric Hospitals Psychiatric Nursing Homes Page 29 30 30 31 32 33 34 34 34 35 36 36 40 41 41 42 42 43 44 44 45 46 46 47 47 48 49 49 49 50 53 53 54 54 VI CHAPTER 5 COMMUNITY SERVICES Paragraph 72 Introductory 73 Out-patient Clinics 74 Domiciliary Consultations 75 Day Hospitals 76-77 Social Work 78-80 Family Care 81 Hostels The Role of the General Practitioner 82 The Role of Public Health Personnel 83 The Role of Voluntary Agencies 84 85 Clubs Financial Assistance to the Mentally 111 86 CHAPTER 6 PROVISION FOR SPECIAL CLASSES Page 55 55 56 57 58 59 61 62 63 64 64 65 87 General (a) Children 66 88 89 90 91 92 93 94 95 96 97 General Prevalence District Child Psychiatric Clinics ... Ascertainment and Referral Regional Child Psychiatric Clinics ... Residential Accommodation Boarding-out in Family Care Education Young Offenders Children in Industrial Schools (b) Adolescents 66 67 67 68 69 69 72 72 73 73 98 99 100 101 102 General Counselling Youth Organisation Residential Requirements Juvenile Delinquency (c) The Aged 74 74 74 75 75 103 104 105 106 General Diagnostic and Assessment Units Early Discovery Co-ordination of services ... 76 76 77 77 VI CHAPTER 5 COMMUNITY SERVICES Paragraph 72 Introductory 73 Out-patient Clinics 74 Domiciliary Consultations 75 Day Hospitals 76-77 Social Work 78-80 Family Care 81 Hostels The Role of the General Practitioner 82 The Role of Public Health Personnel 83 The Role of Voluntary Agencies 84 85 Clubs Financial Assistance to the Mentally 111 86 CHAPTER 6 PROVISION FOR SPECIAL CLASSES Page 55 55 56 57 58 59 61 62 63 64 64 65 87 General (a) Children 66 88 89 90 91 92 93 94 95 96 97 General Prevalence District Child Psychiatric Clinics ... Ascertainment and Referral Regional Child Psychiatric Clinics ... Residential Accommodation Boarding-out in Family Care Education Young Offenders Children in Industrial Schools (b) Adolescents 66 67 67 68 69 69 72 72 73 73 98 99 100 101 102 General Counselling Youth Organisation Residential Requirements Juvenile Delinquency (c) The Aged 74 74 74 75 75 103 104 105 106 General Diagnostic and Assessment Units Early Discovery Co-ordination of services ... 76 76 77 77 VI1 (d) Alcoholics Paragraph 107 General 108 Prevalence 109 Community Treatment Facilities 110 Residential Treatment Facilities 111 Role of Voluntary Agencies ... 112 Research Page 77 79 80 81 82 83 (e) Drug Addicts 113 114 115 General Control of the Use of Drugs ... Treatment Requirements 83 84 85 (/) Epileptics 116 117 118 General Diagnostic Centres Residential Treatment 86 86 87 (g) Persons in Custody 119 120 121 122 123 124 125 126 127 General Definition Historical Note Present Legal Provisions Numbers and Types of Custody Patients Cost of Maintaining Custody Patients Position in Other Countries Need for Special Unit Prisoners other than Custody Patients 88 88 89 89 91 91 91 92 94 (h) Homicidal and Very Violent Patients 128 129 General Need for Change 94 95 0) Psychopaths 130 131 General Treatment 96 97 VI1 (d) Alcoholics Paragraph 107 General 108 Prevalence 109 Community Treatment Facilities 110 Residential Treatment Facilities 111 Role of Voluntary Agencies ... 112 Research Page 77 79 80 81 82 83 (e) Drug Addicts 113 114 115 General Control of the Use of Drugs ... Treatment Requirements 83 84 85 (/) Epileptics 116 117 118 General Diagnostic Centres Residential Treatment 86 86 87 (g) Persons in Custody 119 120 121 122 123 124 125 126 127 General Definition Historical Note Present Legal Provisions Numbers and Types of Custody Patients Cost of Maintaining Custody Patients Position in Other Countries Need for Special Unit Prisoners other than Custody Patients 88 88 89 89 91 91 91 92 94 (h) Homicidal and Very Violent Patients 128 129 General Need for Change 94 95 0) Psychopaths 130 131 General Treatment 96 97 Vlll (k) Persons appearing before the Courts Paragraph 132 General (/) Sexual Deviates 133 134 General .. Treatment Page 98 99 99 CHAPTER 7 PREVENTION AND RESEARCH (A) PREVENTION 135 General ... (a) Primary Prevention 100 136 137 138 139 140 141 142 143 144 General Education and Integration Children and Adolescents Youth Organisations Vulnerable Children and Adolescents Training in Civics Career Guidance Vulnerable Adults Preparation for Retirement (b) Secondary Prevention 100 101 101 102 102 103 103 103 104 145 General (c) Tertiary Prevention 104 146 General 105 (B) RESEARCH 147 148 149 150 151 General Expenditure on Research Nature of Research ... Research Agencies Development of Research 105 105 106 106 109 Vlll (k) Persons appearing before the Courts Paragraph 132 General (/) Sexual Deviates 133 134 General .. Treatment Page 98 99 99 CHAPTER 7 PREVENTION AND RESEARCH (A) PREVENTION 135 General ... (a) Primary Prevention 100 136 137 138 139 140 141 142 143 144 General Education and Integration Children and Adolescents Youth Organisations Vulnerable Children and Adolescents Training in Civics Career Guidance Vulnerable Adults Preparation for Retirement (b) Secondary Prevention 100 101 101 102 102 103 103 103 104 145 General (c) Tertiary Prevention 104 146 General 105 (B) RESEARCH 147 148 149 150 151 General Expenditure on Research Nature of Research ... Research Agencies Development of Research 105 105 106 106 109 IX CHAPTER 8 EDUCATION AND TRAINING Paragraph 152 General (a) Medical Education 153 154 155 Organisation of Medical Education in Ireland Undergraduate Education Post-graduate Education (b) Psychologists 156 General 157-158 Training Facilities in Ireland (c) Psychiatric Nurses 159 160 161 162 163 164 165 166 167 ... Page 101 110 Ill 113 114 115 General 116 Organisation of Psychiatric Nurse Training in Ireland 116 Integration of Training Courses for Nurses ... 117 Present Training Scheme 118 Recruitment of Student Nurses 119 Domiciliary Nursing 119 Refresher Courses 120 Library Facilities 120 Training in Group Leadership and Activation ... 120 (d) Social Workers 168 169 170 General Social Workers--Training Facilities in Ireland ... Psychiatric Social Workers--Training Facilities in Ireland (e) Occupational Therapists 121 121 121 171 172 General Training Facilities in Ireland (/) Mental Hospital Chaplains 122 122 173 174 175 General Training Facilities Role of the Mental Hospital Chaplain 123 124 124 IX CHAPTER 8 EDUCATION AND TRAINING Paragraph 152 General (a) Medical Education 153 154 155 Organisation of Medical Education in Ireland Undergraduate Education Post-graduate Education (b) Psychologists 156 General 157-158 Training Facilities in Ireland (c) Psychiatric Nurses 159 160 161 162 163 164 165 166 167 ... Page 101 110 Ill 113 114 115 General 116 Organisation of Psychiatric Nurse Training in Ireland 116 Integration of Training Courses for Nurses ... 117 Present Training Scheme 118 Recruitment of Student Nurses 119 Domiciliary Nursing 119 Refresher Courses 120 Library Facilities 120 Training in Group Leadership and Activation ... 120 (d) Social Workers 168 169 170 General Social Workers--Training Facilities in Ireland ... Psychiatric Social Workers--Training Facilities in Ireland (e) Occupational Therapists 121 121 121 171 172 General Training Facilities in Ireland (/) Mental Hospital Chaplains 122 122 173 174 175 General Training Facilities Role of the Mental Hospital Chaplain 123 124 124 X (g) Programme of Public Education Paragraph 176 General 177 Psychiatric Services 178 Professional Workers in other Health Fields 179 Teachers 180 Clergy 181 Garda Siochana 182 Legal Profession 183 Trade Union Officials 184 Press, Radio and Television 185 Marriage Guidance Courses Pa8e 124 ... 125 126 126 126 127 127 127 128 CHAPTER 9 ORGANISATION OF SERVICES 186 187 188 189 190 191 192 193 194 195 196 197 198 199 General National Advisory Council National Voluntary Organisation Joint Use of Facilities Medical Staff Structure Administrative and Clerical Staff Flexibility in the use of Nursing Staff Nursing Staff Structure Non-nursing Duties Hospital Committees Area Boundaries Hospital Farms Building Control Organisation of Central Mental Hospital ... 129 129 130 130 131 131 132 133 133 133 134 134 135 135 CHAPTER 10 LEGISLATION 200 General (a) The Reception and Detention of Patients 137 201 202 203 204 Present Provisions Informal Admission Compulsory Admission and Detention Remedies for Improper Detention 138 139 140 141 X (g) Programme of Public Education Paragraph 176 General 177 Psychiatric Services 178 Professional Workers in other Health Fields 179 Teachers 180 Clergy 181 Garda Siochana 182 Legal Profession 183 Trade Union Officials 184 Press, Radio and Television 185 Marriage Guidance Courses Pa8e 124 ... 125 126 126 126 127 127 127 128 CHAPTER 9 ORGANISATION OF SERVICES 186 187 188 189 190 191 192 193 194 195 196 197 198 199 General National Advisory Council National Voluntary Organisation Joint Use of Facilities Medical Staff Structure Administrative and Clerical Staff Flexibility in the use of Nursing Staff Nursing Staff Structure Non-nursing Duties Hospital Committees Area Boundaries Hospital Farms Building Control Organisation of Central Mental Hospital ... 129 129 130 130 131 131 132 133 133 133 134 134 135 135 CHAPTER 10 LEGISLATION 200 General (a) The Reception and Detention of Patients 137 201 202 203 204 Present Provisions Informal Admission Compulsory Admission and Detention Remedies for Improper Detention 138 139 140 141 xi (b) The Registration of Residential Centres for the Mentally III Paragraph 205 Present Provisions 206 Proposed Provisions (c) General 207 208 209 210 211 212 Sheltered Employment Wards of Court Designation of Mental Hospitals Boarding Out in Family Care Transfer of Certain Patients to Central Mental Hospital, Dundrum Absence with Permission CONCLUSION 213 Conclusion APPENDICES Appendix A. Appendix B. Appendix C. Members of the Commission Witnesses Organisations and Persons who submitted Memoranda of Evidence Appendix D. Bibliography Appendix E. Health Authorities Administering Mental Hospitals Appendix F. Approved Staffing Establishments--District Mental Hospitals--31/12/1965 Appendix G. District Mental Hospitals--Out-patient Clinics --31/3/1965 Appendix H. Private Mental Hospitals and Homes ... Appendix I. District Mental Hospitals--areas catered for and patient accommodation Appendix J. Staff in Private Mental Hospitals and Homes 148 149 149 150 160 161 162 169 170 177 146 144 144 145 145 146 146 Page 143 144 xi (b) The Registration of Residential Centres for the Mentally III Paragraph 205 Present Provisions 206 Proposed Provisions (c) General 207 208 209 210 211 212 Sheltered Employment Wards of Court Designation of Mental Hospitals Boarding Out in Family Care Transfer of Certain Patients to Central Mental Hospital, Dundrum Absence with Permission CONCLUSION 213 Conclusion APPENDICES Appendix A. Appendix B. Appendix C. Members of the Commission Witnesses Organisations and Persons who submitted Memoranda of Evidence Appendix D. Bibliography Appendix E. Health Authorities Administering Mental Hospitals Appendix F. Approved Staffing Establishments--District Mental Hospitals--31/12/1965 Appendix G. District Mental Hospitals--Out-patient Clinics --31/3/1965 Appendix H. Private Mental Hospitals and Homes ... Appendix I. District Mental Hospitals--areas catered for and patient accommodation Appendix J. Staff in Private Mental Hospitals and Homes 148 149 149 150 160 161 162 169 170 177 146 144 144 145 145 146 146 Page 143 144 REPORT OF THE COMMISSION OF INQUIRY ON MENTAL ILLNESS SUMMARY (A) GENERAL The Commission's review of the health services for the mentally ill has resulted in this unanimous Report. Mental illness constitutes one of the major health problems of modern society. It has been estimated in other countries that, at present, about one of every three people seeking medical treatment at general practitioner level has a psychiatric aspect to his illness and that about one person in twelve, at some stage of life, is likely to need in-patient psychiatric care. In many countries, 30 per cent to 40 per cent of the hospital beds are assigned to the mentally ill. In Ireland, approximately 7.3 psychiatric beds were provided in 1961 per 1,000 of the population; this rate appears to be the highest in the world and compared with 4.5 in Northern Ireland, 4.6 in England and Wales, 4.3 in Scotland, 2.1 in France and 4.3 in U.S.A. At any given time, about one in every seventy of our people above. the age of 24 years is in a mental hospital. When it is remembered that every mentally ill person brings stress into the lives of people around him, it will be clear that in Ireland mental illness poses a health problem of the first magnitude. While voluntary general hospitals provide limited facilities and private mental hospitals provide approximately 1,000 beds and some out-patient clinics, most of our services, out-patient and residential, are centred on a number of district mental hospitals {containing approximately 18,000 beds) sited throughout the country. A large number of these district mental hospitals were built in the middle years of the last century. Some new buildings have been provided and some old ones have been adequately renovated, but there are still too many barrack-like structures characterised by large wards, gloomy corridors and stone stairways. Too many also have inadequate facilities and services and lack the purposeful activity and therapeutic atmosphere that are necessary in a modern mental hospital. In the Commission's view, a pattern of services confined to the traditional type of mental hospital would leave unfulfilled the need to diagnose and treat as widely as possible incipient mental illness, to provide in whole or in part treatment in the home or in surroundings akin to the patient's normal mode of living, to provide adequate community services and, in particular, it would leave unbridged the gap between psychiatry and general medicine. xiii REPORT OF THE COMMISSION OF INQUIRY ON MENTAL ILLNESS SUMMARY (A) GENERAL The Commission's review of the health services for the mentally ill has resulted in this unanimous Report. Mental illness constitutes one of the major health problems of modern society. It has been estimated in other countries that, at present, about one of every three people seeking medical treatment at general practitioner level has a psychiatric aspect to his illness and that about one person in twelve, at some stage of life, is likely to need in-patient psychiatric care. In many countries, 30 per cent to 40 per cent of the hospital beds are assigned to the mentally ill. In Ireland, approximately 7.3 psychiatric beds were provided in 1961 per 1,000 of the population; this rate appears to be the highest in the world and compared with 4.5 in Northern Ireland, 4.6 in England and Wales, 4.3 in Scotland, 2.1 in France and 4.3 in U.S.A. At any given time, about one in every seventy of our people above. the age of 24 years is in a mental hospital. When it is remembered that every mentally ill person brings stress into the lives of people around him, it will be clear that in Ireland mental illness poses a health problem of the first magnitude. While voluntary general hospitals provide limited facilities and private mental hospitals provide approximately 1,000 beds and some out-patient clinics, most of our services, out-patient and residential, are centred on a number of district mental hospitals {containing approximately 18,000 beds) sited throughout the country. A large number of these district mental hospitals were built in the middle years of the last century. Some new buildings have been provided and some old ones have been adequately renovated, but there are still too many barrack-like structures characterised by large wards, gloomy corridors and stone stairways. Too many also have inadequate facilities and services and lack the purposeful activity and therapeutic atmosphere that are necessary in a modern mental hospital. In the Commission's view, a pattern of services confined to the traditional type of mental hospital would leave unfulfilled the need to diagnose and treat as widely as possible incipient mental illness, to provide in whole or in part treatment in the home or in surroundings akin to the patient's normal mode of living, to provide adequate community services and, in particular, it would leave unbridged the gap between psychiatry and general medicine. xiii XIV One of the first tasks to which the Commission addressed itself was to consider the exceptional rates of residence in the psychiatric hospitals in Ireland. No clear explanation has emerged. There are indications that mental illness may be more prevalent in Ireland than an other countries; however, there are many factors involved, and in the absence of more detailed research, the evidence to this effect cannot be said to be conclusive. Special demographic features, such as the high emigration rate, the low marriage rate and problems of employment, may be relevant to the unusually high rate of hospitalisation. In a largely rural country with few large centres of population, social and geographic isolations may affect both the mental health of individuals and the effectiveness of the mental health services. The public attitude towards mental illness may not be helpful to the discharge of patients and their reintegration in the community. On all these points, the Commission could do little more than ask questions. To provide answers would demand years of scientific inquiry for which neither the personnel of the Commission nor the time at its disposal would have been adequate. The Commission considers that a greatly expanded programme of research, not only into these social and epidemiological problems, but into other aspects of mental illness in Ireland, is urgently necessary. In its effort to chart the course that services for the mentally ill should follow, the Commission considered the services available in a number of countries. In none did it find the ideal or what might be regarded as suitable for the present and future needs of this community. In fact, many of the defects in the Irish services are to be found, in one degree or another, elsewhere. The Commission's recommendations are based on what it believes to be the most enlightened and up-to-date psychiatric knowledge and the preventive, diagnostic, therapeutic and post-therapeutic methods that research and practical experience suggest as being best calculated to deal with mental illness in this community. In the last few decades, psychiatric knowledge and methods have undergone a profound advance; and further progress no doubt lies in the not too distant future. There has been no similar period of time in the past which has seen such a marked improvement in therapeutic practice. The change has been due in part to the therapeutic possibilities opened up by the many pharmaceutical discoveries of recent times; but it has also come from a deeper understanding of the aetiology of mental ailments and of the needs of the mentally ill. As knowledge grows, it may, and doubtless will, be necessary to modify the detailed implementation of some of the Commission's recommendations. Some problems bearing on mental illness--such as the law relating to criminal lunatics--lie outside the Commission's terms of reference and are therefore unexplored in this Report. As to others--such as juvenile delinquency and industrial schools--the Commission recommends that they be made the subject of special studies. While some of the recent advances in psychiatry are already re- XIV One of the first tasks to which the Commission addressed itself was to consider the exceptional rates of residence in the psychiatric hospitals in Ireland. No clear explanation has emerged. There are indications that mental illness may be more prevalent in Ireland than an other countries; however, there are many factors involved, and in the absence of more detailed research, the evidence to this effect cannot be said to be conclusive. Special demographic features, such as the high emigration rate, the low marriage rate and problems of employment, may be relevant to the unusually high rate of hospitalisation. In a largely rural country with few large centres of population, social and geographic isolations may affect both the mental health of individuals and the effectiveness of the mental health services. The public attitude towards mental illness may not be helpful to the discharge of patients and their reintegration in the community. On all these points, the Commission could do little more than ask questions. To provide answers would demand years of scientific inquiry for which neither the personnel of the Commission nor the time at its disposal would have been adequate. The Commission considers that a greatly expanded programme of research, not only into these social and epidemiological problems, but into other aspects of mental illness in Ireland, is urgently necessary. In its effort to chart the course that services for the mentally ill should follow, the Commission considered the services available in a number of countries. In none did it find the ideal or what might be regarded as suitable for the present and future needs of this community. In fact, many of the defects in the Irish services are to be found, in one degree or another, elsewhere. The Commission's recommendations are based on what it believes to be the most enlightened and up-to-date psychiatric knowledge and the preventive, diagnostic, therapeutic and post-therapeutic methods that research and practical experience suggest as being best calculated to deal with mental illness in this community. In the last few decades, psychiatric knowledge and methods have undergone a profound advance; and further progress no doubt lies in the not too distant future. There has been no similar period of time in the past which has seen such a marked improvement in therapeutic practice. The change has been due in part to the therapeutic possibilities opened up by the many pharmaceutical discoveries of recent times; but it has also come from a deeper understanding of the aetiology of mental ailments and of the needs of the mentally ill. As knowledge grows, it may, and doubtless will, be necessary to modify the detailed implementation of some of the Commission's recommendations. Some problems bearing on mental illness--such as the law relating to criminal lunatics--lie outside the Commission's terms of reference and are therefore unexplored in this Report. As to others--such as juvenile delinquency and industrial schools--the Commission recommends that they be made the subject of special studies. While some of the recent advances in psychiatry are already re- XV fleeted in parts of the Irish services, the Commission's recommendations indicate that radical and widespread changes will have to be made if these services are to be brought up to the desired standard. In brief, these recommendations postulate a combination of community services and short-term and long-term hospital treatment. A successful programme for mental health requires the inculcation throughout the community of the basic principles of mental hygiene and an appreciation of, and sympathy with, mental illness and its problems. Many patients can now be successfully treated while living at home or continuing with their work. The Commission's recommendations, therefore, envisage a positive programme of public education, especially for those most likely to come into contact with the mentally ill; services for certain classes, such as children, adolescents and others who may be in need of special care ; the development of community services such as out-patient clinics, day hospitals, hostels, family care, domiciliary consultations; the use in the community, not only of psychiatrists, but also of general practitioners, psychologists, nurses, psychiatric social workers, social workers, voluntary organisations and public health personnel; the development of preventive services and facilities for research, and the co-ordination of all these services with the general programme of preventive and curative medicine. The capacity of modern psychiatry to give good results with intensive and comprehensive in-patient treatment in a great number of cases, together with the desirability of providing such treatment within the ambit of general medicine, has led the Commission to recommend the setting up of short-term residential units in, or in association with, general hospitals. Such units would require to be adequately staffed and equipped, to be associated with the community services of a particular area, to be ready to treat all types of mental illness requiring short-term in-patient care, and to work in close conjunction with the other psychiatric services and with the general hospital. The Commission considers that the siting of these units at, or their association with, general hospitals would benefit both the unit and the general hospital and would be a valuable step towards creating a link between psychiatry and other forms of medicine. For the patient requiring long-term treatment, the Commission recommends the development of long-term hospitals fulfilling a positive and creative role. The aim will be to provide active treatment as well as residential care, to rehabilitate and restore to the community as many patients as possible, and to provide for all patients lives as full and happy as their disabilities permit. Such hospitals and the short-term units should be complementary to each other, and both should be linked with full community services. The Commission's recommendations deal with the services and facilities. in terms of staffing, amenities, purposeful work and activities, and after-care, that should go with such hospitals, so as to ensure due respect for the innate dignity of the patient as an individual and the maximum opportunity for his rehabilitation. Implicit in the Commission's recommendations is the integration XV fleeted in parts of the Irish services, the Commission's recommendations indicate that radical and widespread changes will have to be made if these services are to be brought up to the desired standard. In brief, these recommendations postulate a combination of community services and short-term and long-term hospital treatment. A successful programme for mental health requires the inculcation throughout the community of the basic principles of mental hygiene and an appreciation of, and sympathy with, mental illness and its problems. Many patients can now be successfully treated while living at home or continuing with their work. The Commission's recommendations, therefore, envisage a positive programme of public education, especially for those most likely to come into contact with the mentally ill; services for certain classes, such as children, adolescents and others who may be in need of special care ; the development of community services such as out-patient clinics, day hospitals, hostels, family care, domiciliary consultations; the use in the community, not only of psychiatrists, but also of general practitioners, psychologists, nurses, psychiatric social workers, social workers, voluntary organisations and public health personnel; the development of preventive services and facilities for research, and the co-ordination of all these services with the general programme of preventive and curative medicine. The capacity of modern psychiatry to give good results with intensive and comprehensive in-patient treatment in a great number of cases, together with the desirability of providing such treatment within the ambit of general medicine, has led the Commission to recommend the setting up of short-term residential units in, or in association with, general hospitals. Such units would require to be adequately staffed and equipped, to be associated with the community services of a particular area, to be ready to treat all types of mental illness requiring short-term in-patient care, and to work in close conjunction with the other psychiatric services and with the general hospital. The Commission considers that the siting of these units at, or their association with, general hospitals would benefit both the unit and the general hospital and would be a valuable step towards creating a link between psychiatry and other forms of medicine. For the patient requiring long-term treatment, the Commission recommends the development of long-term hospitals fulfilling a positive and creative role. The aim will be to provide active treatment as well as residential care, to rehabilitate and restore to the community as many patients as possible, and to provide for all patients lives as full and happy as their disabilities permit. Such hospitals and the short-term units should be complementary to each other, and both should be linked with full community services. The Commission's recommendations deal with the services and facilities. in terms of staffing, amenities, purposeful work and activities, and after-care, that should go with such hospitals, so as to ensure due respect for the innate dignity of the patient as an individual and the maximum opportunity for his rehabilitation. Implicit in the Commission's recommendations is the integration XVI of psychiatry with general medicine. The isolation from other forms of medicine in which psychiatrists have worked in the past is seen as undesirable and unnecessary. There is nowadays a growing appreciation of the affinities of the problems of the mentally and physically ill and a realisation that the mental and physical components of illness are frequently overlapping or complementary. The services recommended will require a considerable amount of team work, involving not alone psychiatrists but also psychologists, nurses, psychiatric social workers, and other specially trained persons. There is, at the moment, a shortage of psychiatrists and certain types of paramedical personnel, and the Report deals with the need for them and the question of their training. The general medical practitioner will have a particularly important part to play. It is he who is most likely to have the first opportunity of seeing the patient and diagnosing his problems, and it is he who may have the best opportunity of observing the patient's progress after hospital treatment. It is desirable that he should, as far as possible, be closely associated with the patient's care. The Commission is of opinion that the place accorded to psychiatry at present in the curricula of our medical schools is inadequate to enable doctors in general, and general practitioners in particular, to take their proper part in the psychiatric services. The Commission recommends changes in medical education which should ensure that every medical graduate will have an adequate training in psychiatry and a due appreciation of the importance of the human personality in medical theory and practice. The measures recommended in this Report will require the cooperation of the Department of Health, local health authorities, universities, medical schools, hospital managements, the medical profession, nursing authorities, trade unions, rehabilitation and welfare organisations and other special groups. But they will need, especially, the co-operation of the public at large. Without its enlightened, sympathetic support, no programme promoting community mental health can be successful. The public must he helped to appreciate that mental illness is, in most cases, increasingly amenable to shortterm treatment and that early diagnosis and treatment give the best results. The public should be made familiar with the existence of the range of available services and encouraged to make use of them. The spread of balanced and accurate information on the nature, causes and treatment of mental illnesses will help to break down vestigial fear and distrust, to encourage people to come forward for treatment, and to promote help and understanding for those receiving it. The Commission considers that the formation of enlightened and constructive attitudes throughout the community will need a full progs'(TM)?? ?/ P ^ 1 1 ^ ^ 0 " . Such a programme, directed by the ^Wkil ^ ^ a n d . m a k i n S <*<<*ive <> should be increased. A register of all patients admitted and detained compulsorily should be maintained in every mental hospital or psychiatric unit. The new provisions should apply to all patients already in hospital (either " voluntary " or "detained "); each should be deemed to have been admitted informally unless an extension certificate is made. To provide time for consideration of each case, there should be a transition period during which the patients can be detained under existing powers. Remedies for Improper Detention 204. The principal remedies for any possible improper detention of patients are :-- oSections 165 and 166 deal with the powers of theGardaiSiochana and Assistance Officers to apply for a recommendation to receive into a mental hospital persons believed to be of unsound mind and not under proper care. 141 accordingly. This certificate would authorise the admission of the patient to hospital and his detention for an initial period not exceeding 14 days. As soon as possible after admission, but in any event before the expiry of 14 days, the patient's condition should be thoroughly investigated by an authorised medical officer of consultant status, who could authorise the patient's detention for a further period not exceeding 6 weeks from the date of admission. According to the requirements of the patient's treatment, detention could be further extended, in the first instance for a period not exceeding three months from the date of admission, and subsequently for periods not exceeding twelve months on any one extension. Extensions following the initial periods of 14 days and 6 weeks should be on the basis of certificates signed by two authorised medical officers, at least one of whom should be a psychiatrist approved by the Minister for Health for this purpose. Each medical officer should be required to record on the certificate the reasons why he is satisfied that a further period of detention is necessary. The Commission appreciates that, in some instances, it may be clear that detention over a long period will be required and that it could be contended that the issue of yearly certificates would not be necessary. It is essential, however, to review the condition of all patients at regular intervals and the Commission considers, therefore, that the issue of yearly certificates should not create any unnecessary work. The procedure proposed may give rise to difficulty when a patient refuses to undergo the initial medical examination, or where a medical practitioner is not readily available, or where the patient refuses to go to hospital, or where a relative willing to apply to have him admitted to hospital cannot be traced. The Commission recommends that, to provide for such cases, provisions similar to those in sections 165 and 166* of the Mental Treatment Act, 1945, as amended, should be incorporated in the new legislation. The penalty for obstruction (section 166 (4>> should be increased. A register of all patients admitted and detained compulsorily should be maintained in every mental hospital or psychiatric unit. The new provisions should apply to all patients already in hospital (either " voluntary " or "detained "); each should be deemed to have been admitted informally unless an extension certificate is made. To provide time for consideration of each case, there should be a transition period during which the patients can be detained under existing powers. Remedies for Improper Detention 204. The principal remedies for any possible improper detention of patients are :-- oSections 165 and 166 deal with the powers of theGardaiSiochana and Assistance Officers to apply for a recommendation to receive into a mental hospital persons believed to be of unsound mind and not under proper care. 142 (1) Habeas Corpus--the patient, or someone acting on his behalf, may apply to the High Court for an order that he be released on the ground that he is being unlawfully detained. (2) Any person may apply to the Minister for Health for an Order for the examination of a detained patient by two medical practitioners, and the Minister on consideration of their report, if he thinks fit, may direct the discharge of the patient. (3) The Inspector of Mental Hospitals must visit all mental hospitals at stated intervals, and he has a duty to give special attention to the state of mind of any patient detained where the propriety of detention is doubtful, or when he is requested by the patient, or by any other person, to do so. The Inspector must also ascertain whether the periods of detention of any temporary patients have been extended since his previous visit; and, if so, he must give particular attention to the patients concerned. (4) Any relative or friend of a person detained may make application for the discharge of a patient to his care. The application must be granted unless the medical officer of the hospital certifies that the patient is dangerous or otherwise unfit for discharge, in which event an appeal against refusal of the application lies to the Minister. (5) Every mental hospital authority must appoint a visiting committee, whose duties include that of hearing the complaints of any patient. If requested to do so, they must see the patient in private. (6) When the chief medical officer of a hospital extends the period of detention of a temporary patient, he must advise the patient and the applicant for the original reception order that either of them can send to the Inspector of Mental Hospitals an objection to the extension. On receipt of an objection, the Inspector must take such steps as he deems necessary to satisfy himself of the propriety or otherwise of the continued detention of the patient. If he feels that the patient should not be detained further, he must report the fact to the Minister, who may order the discharge of the patient. (7) Every patient has the right to have a letter forwarded, unopened, to the Minister for Health, the President of the High Court, the Registrar of Wards of Court, the Mental Hospital Authority, a Visiting Committee of a District Mental Hospital or the Inspector of Mental Hospitals. The Minister may arrange for an examination of a patient by the Inspector of Mental Hospitals and may direct his discharge where justified. The President of the High Court may require the Inspector to visit and examine any patient detained as a person of unsound mind and to report to him. 142 (1) Habeas Corpus--the patient, or someone acting on his behalf, may apply to the High Court for an order that he be released on the ground that he is being unlawfully detained. (2) Any person may apply to the Minister for Health for an Order for the examination of a detained patient by two medical practitioners, and the Minister on consideration of their report, if he thinks fit, may direct the discharge of the patient. (3) The Inspector of Mental Hospitals must visit all mental hospitals at stated intervals, and he has a duty to give special attention to the state of mind of any patient detained where the propriety of detention is doubtful, or when he is requested by the patient, or by any other person, to do so. The Inspector must also ascertain whether the periods of detention of any temporary patients have been extended since his previous visit; and, if so, he must give particular attention to the patients concerned. (4) Any relative or friend of a person detained may make application for the discharge of a patient to his care. The application must be granted unless the medical officer of the hospital certifies that the patient is dangerous or otherwise unfit for discharge, in which event an appeal against refusal of the application lies to the Minister. (5) Every mental hospital authority must appoint a visiting committee, whose duties include that of hearing the complaints of any patient. If requested to do so, they must see the patient in private. (6) When the chief medical officer of a hospital extends the period of detention of a temporary patient, he must advise the patient and the applicant for the original reception order that either of them can send to the Inspector of Mental Hospitals an objection to the extension. On receipt of an objection, the Inspector must take such steps as he deems necessary to satisfy himself of the propriety or otherwise of the continued detention of the patient. If he feels that the patient should not be detained further, he must report the fact to the Minister, who may order the discharge of the patient. (7) Every patient has the right to have a letter forwarded, unopened, to the Minister for Health, the President of the High Court, the Registrar of Wards of Court, the Mental Hospital Authority, a Visiting Committee of a District Mental Hospital or the Inspector of Mental Hospitals. The Minister may arrange for an examination of a patient by the Inspector of Mental Hospitals and may direct his discharge where justified. The President of the High Court may require the Inspector to visit and examine any patient detained as a person of unsound mind and to report to him. 143 (8) It is specifically required that a patient who has recovered must be discharged. (9) Penalties are imposed by the Act for detention otherwise than in accordance with the provisions of the Act. The Commission is not aware of any evidence of public disquiet about the effectiveness of the remedies for improper detention now available. They appear to have worked well and the Commission considers them adequate. Some technical amendment will of course be necessary in the light of the changes of procedure the Commission has recommended. (b) THE REGISTRATION OF RESIDENTIAL CENTRES FOR THE MENTALLY I I I Present Provisions 205. Mental hospitals and homes under private management which cater for mentally ill patients are divided into four classes as follows:-- (1) Private charitable institutions, i.e. institutions for the care of persons of unsound mind which are supported wholly or in part by voluntary contributions, which are not kept for profit by any private individual and which are not (a) district mental hospitals or other institutions maintained by mental hospital authorities, or (b) authorised institutions (See (4) below). (2) Private institutions, i.e. institutions or premises in which one or more than one person of unsound mind is or are taken care of for profit and which are not (a) district mental hospitals or other institutions maintained by mental hospital authorities ; (b) private charitable institutions ; or (c) authorised institutions. (3) Approved institutions, i.e. institutions or premises approved by the Minister by Order under section 158 of the Mental Treatment Act as institutions or premises for the reception of temporary and/or voluntary patients. (4) Authorised institutions, i.e. institutions authorised by special Act or other enactment (including a Charter) for the care, maintenance and treatment of persons of unsound mind and not being the Central Mental Hospital. There are only technical differences between the four classes and, for practical purposes, the private mental hospitals and homes are treated to a very large extent as a homogeneous group notwithstanding the very wide differences in the scope and nature of their activities. 143 (8) It is specifically required that a patient who has recovered must be discharged. (9) Penalties are imposed by the Act for detention otherwise than in accordance with the provisions of the Act. The Commission is not aware of any evidence of public disquiet about the effectiveness of the remedies for improper detention now available. They appear to have worked well and the Commission considers them adequate. Some technical amendment will of course be necessary in the light of the changes of procedure the Commission has recommended. (b) THE REGISTRATION OF RESIDENTIAL CENTRES FOR THE MENTALLY I I I Present Provisions 205. Mental hospitals and homes under private management which cater for mentally ill patients are divided into four classes as follows:-- (1) Private charitable institutions, i.e. institutions for the care of persons of unsound mind which are supported wholly or in part by voluntary contributions, which are not kept for profit by any private individual and which are not (a) district mental hospitals or other institutions maintained by mental hospital authorities, or (b) authorised institutions (See (4) below). (2) Private institutions, i.e. institutions or premises in which one or more than one person of unsound mind is or are taken care of for profit and which are not (a) district mental hospitals or other institutions maintained by mental hospital authorities ; (b) private charitable institutions ; or (c) authorised institutions. (3) Approved institutions, i.e. institutions or premises approved by the Minister by Order under section 158 of the Mental Treatment Act as institutions or premises for the reception of temporary and/or voluntary patients. (4) Authorised institutions, i.e. institutions authorised by special Act or other enactment (including a Charter) for the care, maintenance and treatment of persons of unsound mind and not being the Central Mental Hospital. There are only technical differences between the four classes and, for practical purposes, the private mental hospitals and homes are treated to a very large extent as a homogeneous group notwithstanding the very wide differences in the scope and nature of their activities. 144 Proposed Provisions 206. The Commission considers that this classification system is unnecessarily cumbersome and recommends that in future centres for the mentally ill be classified as psychiatric hospitals or as psychiatric nursing homes, according to the type of service provided (see paragraphs 70 and 71). In addition, under the extended services recommended in this Report provision will be required for hostel accommodation (see paragraph 81). All such hospitals, homes or hostels should be registered in a register to be maintained by the Minister for Health and it should be an offence to provide psychiatric care and treatment on a residential basis for mentally ill persons in return for payment except in duly registered hospitals, homes or hostels. An exception should be made in the case of mentally ill persons boarded out in family care. All registered premises should be subject to inspection by the Inspector of Mental Hospitals, but the Minister for Health should be empowered to except particular centres from such inspections. Exemptions however, should not be granted in respect of centres which detain, or propose to detain, patients compulsorily. An exemption could, of course, be withdrawn if it subsequently emerged that there were reasonable grounds to assume that patients were, in fact, being detained. The Commission considers that provision for inspection at least once a year would be adequate. (c) GENERAL Sheltered Employment 207. Health authorities should have power to provide, or to arrange for the provision of, sheltered employment for persons who are either mentally ill or recovering from mental ilhiess. When sheltered employment is provided by voluntary agencies health authorities should be given powers of inspection to ensure that the needs of the persons employed are being adequately met and that appropriate standards are being maintained. Wards of Court 208. The High Court has succeeded to the lunacy jurisdiction formerly delegated by the Crown to the Lord Chancellors, a jurisdiction which was extended and modified by the Lunacy Regulation (Ireland) Act, 1871. This jurisdiction is exercisable by the President of the High Court or by some other Judge of the High Court to whom is may be assigned by him. The Circuit Court exercises a similar jurisdiction under the County Court Jurisdiction in Lunacy (Ireland) Act, 1880, and the Courts (Supplemental Provisions) Act, 144 Proposed Provisions 206. The Commission considers that this classification system is unnecessarily cumbersome and recommends that in future centres for the mentally ill be classified as psychiatric hospitals or as psychiatric nursing homes, according to the type of service provided (see paragraphs 70 and 71). In addition, under the extended services recommended in this Report provision will be required for hostel accommodation (see paragraph 81). All such hospitals, homes or hostels should be registered in a register to be maintained by the Minister for Health and it should be an offence to provide psychiatric care and treatment on a residential basis for mentally ill persons in return for payment except in duly registered hospitals, homes or hostels. An exception should be made in the case of mentally ill persons boarded out in family care. All registered premises should be subject to inspection by the Inspector of Mental Hospitals, but the Minister for Health should be empowered to except particular centres from such inspections. Exemptions however, should not be granted in respect of centres which detain, or propose to detain, patients compulsorily. An exemption could, of course, be withdrawn if it subsequently emerged that there were reasonable grounds to assume that patients were, in fact, being detained. The Commission considers that provision for inspection at least once a year would be adequate. (c) GENERAL Sheltered Employment 207. Health authorities should have power to provide, or to arrange for the provision of, sheltered employment for persons who are either mentally ill or recovering from mental ilhiess. When sheltered employment is provided by voluntary agencies health authorities should be given powers of inspection to ensure that the needs of the persons employed are being adequately met and that appropriate standards are being maintained. Wards of Court 208. The High Court has succeeded to the lunacy jurisdiction formerly delegated by the Crown to the Lord Chancellors, a jurisdiction which was extended and modified by the Lunacy Regulation (Ireland) Act, 1871. This jurisdiction is exercisable by the President of the High Court or by some other Judge of the High Court to whom is may be assigned by him. The Circuit Court exercises a similar jurisdiction under the County Court Jurisdiction in Lunacy (Ireland) Act, 1880, and the Courts (Supplemental Provisions) Act, 145 1961, in cases in which the value of the property of the person in question is below certain limits fixed by these Acts. Section 283 (2) of the Mental Treatment Act, 1945, provides that no power, restriction or prohibition contained in the Act shall apply in relation to a person of unsound mind under the care of a Judge of the High Court or of a Judge of the Circuit Court. The fact that a Ward of Court cannot be admitted to a mental hospital under the provisions of the Mental Treatment Act, 1945, gives rise to serious difficulties. An application to have a person admitted to a mental hospital may have to be made by someone who cannot be expected to know whether he is a Ward of Court or not. As matters stand at present, an application for the admission to a mental hospital of a person whose past history the applicant does not know may result in an illegal detention. The Commission considers that the law should be amended so as to make it lawful for a Ward of Court to be admitted to a mental hospital either under a Court Order or under the statutory provisions applicable to persons who are not Wards of Court. The Commission also thinks it undesirable that mental hospital authorities should have no power to allow Wards of Court out on parole or on trial or to discharge them without the leave of the Court. Restrictions of this kind tend to perpetuate the idea that mental hospitals are primarily places of detention. The Commission accordingly recommends that the law be changed so as to allow mental hospital authorities as much freedom as possible in dealing with patients who are Wards of Court, subject only to such control by the Court as may be considered necessary. Designation of Mental Hospitals 209. Under existing legislation public mental hospitals are formally designated as district mental hospitals, auxiliary mental hospitals or branch mental hospitals. The Commission considers that the designation of psychiatric units in general hospitals by any of these titles would be undesirable and unnecessary. It recommends that provisions in existing legislation requiring the formal designation of hospitals providing psychiatric treatment should be repealed. Boarding Out in Family Care 210. The existing scheme of boarding out in family care for detained mentally ill patients is described in paragraph 78. The Commission recommended in paragraph 80 that provision for a less restricted form of boarding out should be made in the future --in particular the requirement that only one patient can be boarded out in any one dwelling should be removed. The legislation recommended in this Chapter should include provisions to give effect to these recommendations. 145 1961, in cases in which the value of the property of the person in question is below certain limits fixed by these Acts. Section 283 (2) of the Mental Treatment Act, 1945, provides that no power, restriction or prohibition contained in the Act shall apply in relation to a person of unsound mind under the care of a Judge of the High Court or of a Judge of the Circuit Court. The fact that a Ward of Court cannot be admitted to a mental hospital under the provisions of the Mental Treatment Act, 1945, gives rise to serious difficulties. An application to have a person admitted to a mental hospital may have to be made by someone who cannot be expected to know whether he is a Ward of Court or not. As matters stand at present, an application for the admission to a mental hospital of a person whose past history the applicant does not know may result in an illegal detention. The Commission considers that the law should be amended so as to make it lawful for a Ward of Court to be admitted to a mental hospital either under a Court Order or under the statutory provisions applicable to persons who are not Wards of Court. The Commission also thinks it undesirable that mental hospital authorities should have no power to allow Wards of Court out on parole or on trial or to discharge them without the leave of the Court. Restrictions of this kind tend to perpetuate the idea that mental hospitals are primarily places of detention. The Commission accordingly recommends that the law be changed so as to allow mental hospital authorities as much freedom as possible in dealing with patients who are Wards of Court, subject only to such control by the Court as may be considered necessary. Designation of Mental Hospitals 209. Under existing legislation public mental hospitals are formally designated as district mental hospitals, auxiliary mental hospitals or branch mental hospitals. The Commission considers that the designation of psychiatric units in general hospitals by any of these titles would be undesirable and unnecessary. It recommends that provisions in existing legislation requiring the formal designation of hospitals providing psychiatric treatment should be repealed. Boarding Out in Family Care 210. The existing scheme of boarding out in family care for detained mentally ill patients is described in paragraph 78. The Commission recommended in paragraph 80 that provision for a less restricted form of boarding out should be made in the future --in particular the requirement that only one patient can be boarded out in any one dwelling should be removed. The legislation recommended in this Chapter should include provisions to give effect to these recommendations. 146 Transfer of Certain Patients to the Central Mental Hospital, Dundrum 211. The Commission recommends in paragraph 129 thai the procedure under which homicidal and very violent patients are transferred from district mental hospitals should be changed to one of medical certification. Legislation will be necessary to give effect to the recommendations in that paragraph. Absence with Permission 212. Under existing legislation detained patients may be allowed to be absent from hospital on "parole" for periods not exceeding 48 hours and to be absent on trial for periods up to 90 days. The Commission recommends that these provisions be replaced by one allowing " absence with permission " for periods up to 90 days. Any detained patient who has completed 90 days permitted absence should be discharged. CONCLUSION 213. We wish to express our appreciation of the great help which we received from our Secretary, Mr. C. Mulvihill. The requirements of the Commission necessitated his working at high pressure on numerous occasions, but he was invariably cheerful and optimistic and he showed most exceptional skill and energy in drafting the report and in dealing with all the arduous tasks entrusted to him. We owe him a very special debt of gratitude for his unfailing and friendly co-operation with us at all times. Mr. Mulvihill was ably assisted by Mr. O. Hogan who acted as his deputy on various occasions, by Mr. S. Murphy who gave considerable help in finalising the report and by Miss M. Brady and Miss J. Blehein who arranged most of our meetings, visits, travel and accommodation requirements. We are most grateful to them all for their help. We are also grateful to the staff of the Department of Health which furnished us with any information we required and assisted us in various ways. We are particularly appreciative of the splendid service provided by the Typing Section throughout our Inquiry. Finally, two members of the Commission, Mr. J. J. Darby and Dr. B. MacM. Ramsay, both of the Department of Health, must be especially thanked by their fellow-members for the amount of work they put into the compilation of this Report and for the many ways in which they helped with their wide knowledge and experience of the problems involved. 146 Transfer of Certain Patients to the Central Mental Hospital, Dundrum 211. The Commission recommends in paragraph 129 thai the procedure under which homicidal and very violent patients are transferred from district mental hospitals should be changed to one of medical certification. Legislation will be necessary to give effect to the recommendations in that paragraph. Absence with Permission 212. Under existing legislation detained patients may be allowed to be absent from hospital on "parole" for periods not exceeding 48 hours and to be absent on trial for periods up to 90 days. The Commission recommends that these provisions be replaced by one allowing " absence with permission " for periods up to 90 days. Any detained patient who has completed 90 days permitted absence should be discharged. CONCLUSION 213. We wish to express our appreciation of the great help which we received from our Secretary, Mr. C. Mulvihill. The requirements of the Commission necessitated his working at high pressure on numerous occasions, but he was invariably cheerful and optimistic and he showed most exceptional skill and energy in drafting the report and in dealing with all the arduous tasks entrusted to him. We owe him a very special debt of gratitude for his unfailing and friendly co-operation with us at all times. Mr. Mulvihill was ably assisted by Mr. O. Hogan who acted as his deputy on various occasions, by Mr. S. Murphy who gave considerable help in finalising the report and by Miss M. Brady and Miss J. Blehein who arranged most of our meetings, visits, travel and accommodation requirements. We are most grateful to them all for their help. We are also grateful to the staff of the Department of Health which furnished us with any information we required and assisted us in various ways. We are particularly appreciative of the splendid service provided by the Typing Section throughout our Inquiry. Finally, two members of the Commission, Mr. J. J. Darby and Dr. B. MacM. Ramsay, both of the Department of Health, must be especially thanked by their fellow-members for the amount of work they put into the compilation of this Report and for the many ways in which they helped with their wide knowledge and experience of the problems involved. 147 Signed Seamus Henchy (Chairman) Leslie, Bean T. de Barra J. C. Barrett J. F. Carroll Mrs. E. Crowley Miss R. Cunningham J. J. Darby G. P. Egan O. W. S. FitzGerald J. V. Glass M. B. Holohan D. W. K. Kay G. G. King M. Macken J. N. P. Moore Rev. E. F. O'Doherty S. O'Hanlon D. Quigley B. MacM. Ramsay A. J. Reeves M. Roth P. Smith J. Smithers J. J. Stack E. Timmons M. Viney C J. Mulvihill (Secretary) 1st July, 1966. 147 Signed Seamus Henchy (Chairman) Leslie, Bean T. de Barra J. C. Barrett J. F. Carroll Mrs. E. Crowley Miss R. Cunningham J. J. Darby G. P. Egan O. W. S. FitzGerald J. V. Glass M. B. Holohan D. W. K. Kay G. G. King M. Macken J. N. P. Moore Rev. E. F. O'Doherty S. O'Hanlon D. Quigley B. MacM. Ramsay A. J. Reeves M. Roth P. Smith J. Smithers J. J. Stack E. Timmons M. Viney C J. Mulvihill (Secretary) 1st July, 1966. APPENDIX A MEMBERS OF THE COMMISSION The Hon. Mr. Justice Henchy (Chairman). Leslie Bean de Barra. J. C. Barrett, Esq. J. F. Carroll, Esq. Mrs. E. Crowley, S.R.N., R.M.N., S.C.M., R.F.N. Miss R. Cunningham, R.G.N., R.M. J. J. Darby, Esq. G. P. Egan, Esq., M.D., D.P.M. O. W. S. FitzGerald, Esq., M.A., M.D., D.P.M. J. V. Glass, Esq., M.B., B.Ch., B.A.O., D.P.M. M. B. Holohan, Esq., M.B., B.Ch., B.A.O. D. W. K. Kay, Esq., M.A., D.M., D.P.M. G. G. King, Esq., LL.B., Barrister-at-Law. M. Macken, Esq. J. N. P. Moore, Esq., B.A., M.D., F.R.C.P.I., D.P.M. Rev. Professor E. F. O'Doherty, M.A., B.D., Ph.D. S. O'Hanlon, Esq. D. Quigley, Esq., Barrister-at-Law. B. MacM. Ramsay, Esq., M.B., B.Ch., B.A.O., L.M., D.P.M. A. J. Reeves, Esq., M.A., M.D., D.P.H. Professor M. Roth, M.D., F.R.C.P., D.P.M. P. Smith, Esq. J. Smithers, Esq. J. J. Stack, Esq., M.D., D.P.M., D.C.H. E. Timmons, Esq., P.C. M. Viney, Esq. C. J. Mulvihill, Esq. (Secretary). The following members of the Commission died : (1) N. J. Burke, Esq., 8th April, 1965; (2) V. G. Crotty, Esq., M.B., B.Ch., B.A.O, D.P.M., 13th December, 1964. The following members resigned : (1) The Hon. Mr. Justice Martin C Maguire, 19th September, 1962; (2) Rev. J. Erraught, S.J., 2nd April, 1963; (3) L. G. Kiloh, Esq., B.Sc., M.D., D.P.M., 1st October, 1962; (4) J. P. McCann, Esq.. L.R.C.P.I., 20th September, 1962. The following members were appointed after the establishment of the Commission: (1) The Hon. Mr. Justice Henchy, 24th September, 1962; (2) J. V. Glass. Esq.. M.B.. B.Ch., B.A.O., D.P.M., 2nd June, 1965; (3) M. B. Holohan, Esq., M.B. B.Ch.. B.A.O., 10th December. 1962; (4) D. W. K. Kay. Esq.. M.A.. D.M.. D.P.M., 7th August, 1963; (5) L. G. Kiloh, Esq., B.Sc., M.D., D.P.M., 8th February, 1962; (6) M. Viney, Esq., 16th July, 1965. 148 APPENDIX A MEMBERS OF THE COMMISSION The Hon. Mr. Justice Henchy (Chairman). Leslie Bean de Barra. J. C. Barrett, Esq. J. F. Carroll, Esq. Mrs. E. Crowley, S.R.N., R.M.N., S.C.M., R.F.N. Miss R. Cunningham, R.G.N., R.M. J. J. Darby, Esq. G. P. Egan, Esq., M.D., D.P.M. O. W. S. FitzGerald, Esq., M.A., M.D., D.P.M. J. V. Glass, Esq., M.B., B.Ch., B.A.O., D.P.M. M. B. Holohan, Esq., M.B., B.Ch., B.A.O. D. W. K. Kay, Esq., M.A., D.M., D.P.M. G. G. King, Esq., LL.B., Barrister-at-Law. M. Macken, Esq. J. N. P. Moore, Esq., B.A., M.D., F.R.C.P.I., D.P.M. Rev. Professor E. F. O'Doherty, M.A., B.D., Ph.D. S. O'Hanlon, Esq. D. Quigley, Esq., Barrister-at-Law. B. MacM. Ramsay, Esq., M.B., B.Ch., B.A.O., L.M., D.P.M. A. J. Reeves, Esq., M.A., M.D., D.P.H. Professor M. Roth, M.D., F.R.C.P., D.P.M. P. Smith, Esq. J. Smithers, Esq. J. J. Stack, Esq., M.D., D.P.M., D.C.H. E. Timmons, Esq., P.C. M. Viney, Esq. C. J. Mulvihill, Esq. (Secretary). The following members of the Commission died : (1) N. J. Burke, Esq., 8th April, 1965; (2) V. G. Crotty, Esq., M.B., B.Ch., B.A.O, D.P.M., 13th December, 1964. The following members resigned : (1) The Hon. Mr. Justice Martin C Maguire, 19th September, 1962; (2) Rev. J. Erraught, S.J., 2nd April, 1963; (3) L. G. Kiloh, Esq., B.Sc., M.D., D.P.M., 1st October, 1962; (4) J. P. McCann, Esq.. L.R.C.P.I., 20th September, 1962. The following members were appointed after the establishment of the Commission: (1) The Hon. Mr. Justice Henchy, 24th September, 1962; (2) J. V. Glass. Esq.. M.B.. B.Ch., B.A.O., D.P.M., 2nd June, 1965; (3) M. B. Holohan, Esq., M.B. B.Ch.. B.A.O., 10th December. 1962; (4) D. W. K. Kay. Esq.. M.A.. D.M.. D.P.M., 7th August, 1963; (5) L. G. Kiloh, Esq., B.Sc., M.D., D.P.M., 8th February, 1962; (6) M. Viney, Esq., 16th July, 1965. 148 149 APPENDDC B LIST OF WITNESSES (1) National Organisation for Rehabilitation--represented by Dr. T. Gregg, Medical Director, and Mr. C. Sweeney, Secretary. (2) District Justice E. O'Riain. (3) Royal Medico Psychological Association (Irish Division)-- represented by Dr. C. B. Robinson (Purdysburn Hospital, Belfast), Chairman, Irish Division; Professor John Dunne, Professor of Psychiatry, University College, Dublin; Dr. Desmond McGrath, Medical Director, St. John of God Psychiatric Hospital, Stillorgan; Dr. John Hill, R.M.S., District Mental Hospital, Portlaoise, and Dr. Mary Sullivan, Verville Retreat, Clontarf, Dublin; Secretary, Irish Division; (4) Dr. D. Walsh, St. Loman's Hospital, Ballyowen, Dublin. APPENDIX C ORGANISATIONS AND PERSONS WHO SUBMITTED MEMORANDA OF EVIDENCE (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Dr. T. F. Armstrong. Association of Parents and Friends of Autistic Children. Miss Cecilia Barrett. Miss E. M. Bergin. An Bord Altranais. Mr. Patrick Byrnes. Mr. Con Callanan. Carlow-Kildare Mental Health Board. Mrs. Mary Casserly. Dr. P. J. Cassin. Catholic Women's Federation of Secondary School Unions. Cavan-Monaghan Mental Health Board. Dr. J. J. Clarke. Mr. Daniel Cronin. Mr. Myles Dockrell. Mr. T. P. Gillie. Miss Myrtle Glass. Mr. James Haire, M.P.S.I. 149 APPENDDC B LIST OF WITNESSES (1) National Organisation for Rehabilitation--represented by Dr. T. Gregg, Medical Director, and Mr. C. Sweeney, Secretary. (2) District Justice E. O'Riain. (3) Royal Medico Psychological Association (Irish Division)-- represented by Dr. C. B. Robinson (Purdysburn Hospital, Belfast), Chairman, Irish Division; Professor John Dunne, Professor of Psychiatry, University College, Dublin; Dr. Desmond McGrath, Medical Director, St. John of God Psychiatric Hospital, Stillorgan; Dr. John Hill, R.M.S., District Mental Hospital, Portlaoise, and Dr. Mary Sullivan, Verville Retreat, Clontarf, Dublin; Secretary, Irish Division; (4) Dr. D. Walsh, St. Loman's Hospital, Ballyowen, Dublin. APPENDIX C ORGANISATIONS AND PERSONS WHO SUBMITTED MEMORANDA OF EVIDENCE (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Dr. T. F. Armstrong. Association of Parents and Friends of Autistic Children. Miss Cecilia Barrett. Miss E. M. Bergin. An Bord Altranais. Mr. Patrick Byrnes. Mr. Con Callanan. Carlow-Kildare Mental Health Board. Mrs. Mary Casserly. Dr. P. J. Cassin. Catholic Women's Federation of Secondary School Unions. Cavan-Monaghan Mental Health Board. Dr. J. J. Clarke. Mr. Daniel Cronin. Mr. Myles Dockrell. Mr. T. P. Gillie. Miss Myrtle Glass. Mr. James Haire, M.P.S.I. 150 (19) Dr. B. F. Honan. (20) Irish Countrywomen's Association. (21) Irish Medical Association. (22) The Irish Nurses' Organisation. (23) Messrs. J. T. Kavanagh and E. Nangle. (24) Mr. Bartley Keane. (25) Longford-Meath-Westmeath Mental Health Board. (26) Miss Brigid McDonald. (27) Miss Maud McKenna. (28) Mr. Stephen McLoughlin. (29) Mr. D. P. Murphy. (30) Mrs. Bridget O'Callaghan. (31) Mr. John O'Connor. (32) Dr. J. H. O'Donnell. (33) Mrs. K. O'Gara. (34) Seamus S. 6 Ghormleaghaigh, Uas. (35) Mrs. Mary O'Grady. (36) Mr. Michael O'Meara. (37) National Organisation for Rehabilitation. (38) Rev. Dr. J. G. O'Neill. (39) Mr. Ignatius O'Rourke. (40) District Justice E. O'Riain. (41) Dr. E. N. M. O'SulKvan. (42) Dr. P. J. Power. (43) The Rehabilitation Institution. (44) Royal Medico-Psychological Association (Irish Division). (45) Mr. K. Ryan. (46) Dr. J. R. Shea. (47) Society of Medical Officers of Health. (48) Southern Members of Irish Region of British Association of Psychiatric Social Workers. (49) Miss K. Sweeney. (50) Dr. Dermot Walsh. (51) Waterford Health Authority. BIBLIOGRAPHY. APPENDIX D. A.A. (1957). Alcoholics Anonymous Comes of Age. New York: Alcoholics Anonymous Publishing, Inc. Abraham, G. W. (1886). Law and Practice of Lunacy in Ireland. Dublin. Abrahams, S. I. (1961). The role of the family doctor in mental health. /. Soc. M.O.H. 75, 85-89. Ackner, B. (1964). Ed. Handbook for Psychiatric Nurses, 9th edn. London: R.M.P.A. Publics. Alcoholism (1952). European Seminar and Lecture Course, Copenhagen, Oct.-Nov., 1951, report. Geneva: W.H.O. Alonso, A. M. (1960). What is mental health? Who is mentally healthy? Int. J. soc. Psychiat., 3 & 4 302-305. Annesley, P. T. (1961). Psychiatric illness in adolescence. /. Ment. ScL, 107, 268-278. 150 (19) Dr. B. F. Honan. (20) Irish Countrywomen's Association. (21) Irish Medical Association. (22) The Irish Nurses' Organisation. (23) Messrs. J. T. Kavanagh and E. Nangle. (24) Mr. Bartley Keane. (25) Longford-Meath-Westmeath Mental Health Board. (26) Miss Brigid McDonald. (27) Miss Maud McKenna. (28) Mr. Stephen McLoughlin. (29) Mr. D. P. Murphy. (30) Mrs. Bridget O'Callaghan. (31) Mr. John O'Connor. (32) Dr. J. H. O'Donnell. (33) Mrs. K. O'Gara. (34) Seamus S. 6 Ghormleaghaigh, Uas. (35) Mrs. Mary O'Grady. (36) Mr. Michael O'Meara. (37) National Organisation for Rehabilitation. (38) Rev. Dr. J. G. O'Neill. (39) Mr. Ignatius O'Rourke. (40) District Justice E. O'Riain. (41) Dr. E. N. M. O'SulKvan. (42) Dr. P. J. Power. (43) The Rehabilitation Institution. (44) Royal Medico-Psychological Association (Irish Division). (45) Mr. K. Ryan. (46) Dr. J. R. Shea. (47) Society of Medical Officers of Health. (48) Southern Members of Irish Region of British Association of Psychiatric Social Workers. (49) Miss K. Sweeney. (50) Dr. Dermot Walsh. (51) Waterford Health Authority. BIBLIOGRAPHY. APPENDIX D. A.A. (1957). Alcoholics Anonymous Comes of Age. New York: Alcoholics Anonymous Publishing, Inc. Abraham, G. W. (1886). Law and Practice of Lunacy in Ireland. Dublin. Abrahams, S. I. (1961). The role of the family doctor in mental health. /. Soc. M.O.H. 75, 85-89. Ackner, B. (1964). Ed. Handbook for Psychiatric Nurses, 9th edn. London: R.M.P.A. Publics. Alcoholism (1952). European Seminar and Lecture Course, Copenhagen, Oct.-Nov., 1951, report. Geneva: W.H.O. Alonso, A. M. (1960). What is mental health? Who is mentally healthy? Int. J. soc. Psychiat., 3 & 4 302-305. Annesley, P. T. (1961). Psychiatric illness in adolescence. /. Ment. ScL, 107, 268-278. 151 Apley, J. Philips, M. & Westmacott I. (1960). Psychogenic disorders in children. Brit. Med. J. 1,191-192. Aron, K. W. & Smith, S. (1953). The Bristol Day Hospital. /. Merit. Sci., 99, 564. Association of Parents and Friends of Autistic Children (1965). Dublin. Report of Study Tour in the U.S.A. (unpublished). Aungle, P. G. (1959). The care and treatment of pyschiatric offenders in Norway, Sweden and Denmark. /. Ment. Sci., 105, 428-39. Autistic Children--Wing L. London: N.A.M.H. Autistic Children--How many Autistic Children? (1965). The Medical Officer, 113, 43. Axel, A. (1959). The treatment of schizophrenia in a Day Hospital. Int. J. soc. Psychiat., 3, 174-181. Baker, A. A. (1959). Mother and Baby Unit. Nursing Times, Oct. 9th. Monson, M., Game, J. A. & Thorpe, J. G. (1961). Admitting schizophrenic mothers with their babies. Lancet, 2, 237-239. Bales, R. F. (1946). Cultural Differences in Rates of Alcoholism. Quart. J. Stud., A l e , 6, 480-499. Barton, R. (1959). Institutional Neurosis. Bristol: J. Wright & Sons. (1965). The interdependence of Hospital, G.P. and Community Care. London: Medical World, 105, 361-365. et. alia (1965). A new psychiatric unit for a mixed urban and rural population. Medical Officer, 113, 3-5. Barton, W. E. (1960). Family care and outpatient psychiatry. Amer. J. Psychiat., 116,644-647. Becker, A., Murphy, N. M. & Greenblatt (1965). Recent advances in community psychiatry. New Eng. Jour, of Med., 272, 621-626 and 674-679. Bender, L. (1954). Symposium on Juvenile Schizophrenia. In: Neurology and Psychiatry in Childhood. Association for Research in Nervous and Mental Disease, New York, 576. Berrington, W. P. (1966). Re-socialisation: undoing the damage. Int. J. soc. Psychiat., 2, 85-97. Bickford, J. A. R. (1966). Outside teachers inside a mental hospital. Lancet, 1,1,200. Bierer, J. (1951). The Day Hospital. London: Lewis. (1961). Day Hospitals: further developments. Int. J. soc. Psychiat., 7, 148. Blacker, C. P. (1946). Neurosis and the Mental Health Services. London: Oxford Medical Publics. Bolton, A. (1955). A prophylactic approach to child psychiatry. /. Ment. Set'., 101, 696-703. Bovet, Lucien (1951). Psychiatric Aspects of Juvenile Delinquency. W.H.O. Monograph Series, No. 1. Bowlby, J. (1951). Maternal Care and Mental Health--W.H.O. Monograph Series No. 2. Brit. Med. J. (1956). Problem Families, 1, 103-104. (1962). Mental Disorder in Old Age, 2, 662. (1962). Family influence on Schizophrenia, 2, 1,595. (1963). Epilepsy and Schizophrenia, 1,1557-8. (1963) Psychiatric Services of the Future, 2, 350-351. (1965). Control of Drug Addiction, 2, 1,259-1,260. (1965). Management of Adolescent Patients, 2,1364-1,365. (1965). Readmission Rates in Schizophrenia, 2, 1,447-1,448. (1966). Maladjusted Children, 1, 440. (1966). Demonstration of Psychiatric Rehabilitation, 1, 1.100.& Brooke, E. (1958). Recent progress in Mental Health statistics. Monthly Bulletin, Min. of Health, Vol. 17, 208, London. Brooke, E. (1959). National Statistics in the epidemiology of mental illness. /. Ment. Sci., 105, 893-898. (1962). Factors affecting the demand for psychiatric beds. Lancet, 2, 1211. (1963). Cohort study of patients first admitted to mental hospitals in 19541955. London: H.M.S.O. Brown, G. W., Carstairs, G. M. and Topping, G. (1958). Post hospital adjustment of chronic mental patients. Lancet, 2, 685-689. Browne, I. W. (1963). Psychiatry in Ireland. Amer. J. Psychiat., 119,9,816-819. Browne, I. W. and Walsh, D. (1965). Training for Psychiatry. /. Irish Med. Association, 335, 158-160. Buckle, D. and Lebovici, S. (1960). Child Guidance Centres. W.H.O. Geneva. Burbury, W. M. (1959). Mental Health in the Public Health field. /. Soc. M.O.H. LXXXIII, 145-149. Caplan, G. (1961). An approach to Community Mental Health. London: Tavistock Publics. 151 Apley, J. Philips, M. & Westmacott I. (1960). Psychogenic disorders in children. Brit. Med. J. 1,191-192. Aron, K. W. & Smith, S. (1953). The Bristol Day Hospital. /. Merit. Sci., 99, 564. Association of Parents and Friends of Autistic Children (1965). Dublin. Report of Study Tour in the U.S.A. (unpublished). Aungle, P. G. (1959). The care and treatment of pyschiatric offenders in Norway, Sweden and Denmark. /. Ment. Sci., 105, 428-39. Autistic Children--Wing L. London: N.A.M.H. Autistic Children--How many Autistic Children? (1965). The Medical Officer, 113, 43. Axel, A. (1959). The treatment of schizophrenia in a Day Hospital. Int. J. soc. Psychiat., 3, 174-181. Baker, A. A. (1959). Mother and Baby Unit. Nursing Times, Oct. 9th. Monson, M., Game, J. A. & Thorpe, J. G. (1961). Admitting schizophrenic mothers with their babies. Lancet, 2, 237-239. Bales, R. F. (1946). Cultural Differences in Rates of Alcoholism. Quart. J. Stud., A l e , 6, 480-499. Barton, R. (1959). Institutional Neurosis. Bristol: J. Wright & Sons. (1965). The interdependence of Hospital, G.P. and Community Care. London: Medical World, 105, 361-365. et. alia (1965). A new psychiatric unit for a mixed urban and rural population. Medical Officer, 113, 3-5. Barton, W. E. (1960). Family care and outpatient psychiatry. Amer. J. Psychiat., 116,644-647. Becker, A., Murphy, N. M. & Greenblatt (1965). Recent advances in community psychiatry. New Eng. Jour, of Med., 272, 621-626 and 674-679. Bender, L. (1954). Symposium on Juvenile Schizophrenia. In: Neurology and Psychiatry in Childhood. Association for Research in Nervous and Mental Disease, New York, 576. Berrington, W. P. (1966). Re-socialisation: undoing the damage. Int. J. soc. Psychiat., 2, 85-97. Bickford, J. A. R. (1966). Outside teachers inside a mental hospital. Lancet, 1,1,200. Bierer, J. (1951). The Day Hospital. London: Lewis. (1961). Day Hospitals: further developments. Int. J. soc. Psychiat., 7, 148. Blacker, C. P. (1946). Neurosis and the Mental Health Services. London: Oxford Medical Publics. Bolton, A. (1955). A prophylactic approach to child psychiatry. /. Ment. Set'., 101, 696-703. Bovet, Lucien (1951). Psychiatric Aspects of Juvenile Delinquency. W.H.O. Monograph Series, No. 1. Bowlby, J. (1951). Maternal Care and Mental Health--W.H.O. Monograph Series No. 2. Brit. Med. J. (1956). Problem Families, 1, 103-104. (1962). Mental Disorder in Old Age, 2, 662. (1962). Family influence on Schizophrenia, 2, 1,595. (1963). Epilepsy and Schizophrenia, 1,1557-8. (1963) Psychiatric Services of the Future, 2, 350-351. (1965). Control of Drug Addiction, 2, 1,259-1,260. (1965). Management of Adolescent Patients, 2,1364-1,365. (1965). Readmission Rates in Schizophrenia, 2, 1,447-1,448. (1966). Maladjusted Children, 1, 440. (1966). Demonstration of Psychiatric Rehabilitation, 1, 1.100.& Brooke, E. (1958). Recent progress in Mental Health statistics. Monthly Bulletin, Min. of Health, Vol. 17, 208, London. Brooke, E. (1959). National Statistics in the epidemiology of mental illness. /. Ment. Sci., 105, 893-898. (1962). Factors affecting the demand for psychiatric beds. Lancet, 2, 1211. (1963). Cohort study of patients first admitted to mental hospitals in 19541955. London: H.M.S.O. Brown, G. W., Carstairs, G. M. and Topping, G. (1958). Post hospital adjustment of chronic mental patients. Lancet, 2, 685-689. Browne, I. W. (1963). Psychiatry in Ireland. Amer. J. Psychiat., 119,9,816-819. Browne, I. W. and Walsh, D. (1965). Training for Psychiatry. /. Irish Med. Association, 335, 158-160. Buckle, D. and Lebovici, S. (1960). Child Guidance Centres. W.H.O. Geneva. Burbury, W. M. (1959). Mental Health in the Public Health field. /. Soc. M.O.H. LXXXIII, 145-149. Caplan, G. (1961). An approach to Community Mental Health. London: Tavistock Publics. 152 Caplan.G. (1961).-Prevention of Mental Disorder in Children. New York: Basic Books Carse, J. Panton, N. and Watts, A. (1958). A district mental hospital ssrvice. Lancet 1,39. Carse, J. (1959). The Worthing experiment. S. W. 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Occupational Therapy for the elderly confused patient. /. Irish Med. Assocn., 42, 168-169. Sheridan, M. (1956). Intelligence of neglectful mothers. Brit. Med. J., 1, 91-93. (1960). Developmental progress of infants and young children. H.M.S.O. Sigerson, G. (1886). Law and the Lunatic. Dublin. Silverman, M. (1961). A comprehensive department of psychological medicine. Brit. Med. J., 2, 698-701. Slater, E. and Beard, A. W. (1963). The schizophrenia--like psychosis of Epilepsy. Brit. J. Psychiat., 109, 95-150. Smith, S., Gibb, G. M. and Martin, A. A. (1963). Using Mental Hospitals for other purposes. Lancet, 2, 398-400. Smith, S. (1960). Review of the Psychiatric Units associated with General Hospitals. in the area of the Manchester Regional Board. Manchester: R.H.B. (1961). Psychiatry in general hospitals--Manchester's integrated scheme. Lancet, 1, 1158. (1963). The Concept of Industrial Therapy. Brit. Hospital and Social Services J. 27th December, 1589-1591. Sproule, B. J. (1966). Psychiatric Social Worker attachment to a general practitioner. Practitioner, 196, 833. Stafford-Clarke. (1963). Psychiatry to-day. 2nd edition. Penguin Books. Stanton, A. and Schwartz, M. (1954). The Mental Hospital. London : Tavistock Publics. Stern, E. S. (1959). Open wards in large mental hospitals. Int. J. Soc. Psychiat., 4, 299-302. Stone, J. A. W. and Evans, A. E. (1938). The boarding out of mental patients in the Scottish Highlands. /. Ment. Sci., 84, 381. Stromgren, E. (1958). Mental Health Service Planning in Denmark. Copenhagen: Olaf Mollers. Stump, G. K. (1952). The treatment of criminal psychopaths at Herstedvester. Br. Jour, of Med. Psychol., 25, 31. Tetlow, C. (1955). Psychosis of childbearing. /. Ment. Sci., 101, 629-639. (1957). Medical administration in mental hospitals. Lancet, 1, 89. The Distant Goal. (1963). Annual Conference. London : N.A.M.H. Tibbits, J. C. N. and Harbet, W. B. (I960). A trial of discharge and after care of long-stay mental hospital patients. Brit. Med. J., 2, 435-6. Toward Therapeutic Care (1965). Formulated by the Committee on Psychiatric Nursing. Group for Advancement of Psychiatry, New York. Tooth, G. C. and Brooke, E. (1961). Trends in the mental hospital population and their effects on future planning. Lancet, 1. 710-713. Tuairim. (1966). Some of Our Children. A report on the residential care of the deprived child in Ireland. Tuairim pamphlet by the London Branch Study Group. London: Norma Press Ltd. Townsend, P. (1962). The last Refuge--a survey of residential institutions and homes for the aged in England and Wales. London: Routledge and Kegan Paul. Trends in the Mental Health Services. (1963). Ed. Freeman, H. L. and Farndale, J., London : Pergamon Press. Tuke, D. H. (1882). Chapters in the History of the Insane in the British Isles. London. Vallance, M. (1965). Alcoholism : a two year follow-up study of patients admitted to the psychiatric department of a general hospital. Brit. J. Psychiat., I l l , 348-356. Veil, C. (1962). Psychiatric services. Rept. of symposium on Hospital and Domiciliary Care, Amsterdam, 19th-23rd November, 1962. Copenhagen : W.H.O. regional office for Europe. Viney, M. (1963). Mental Illness: An Inquiry--Dublin: Irish Times Ltd. (1964). Alcoholism in Ireland: An Inquiry--Dublin: Irish Times Ltd. Wadsworth, W. V., Wells, B. W. P. and Scott, R. E. (1962). The employability of chronic schizophrenics. /. Ment. Sci., 108, 300-303. (1962). The organisation of a sheltered workshop. /. Ment. Sci., 108, 780-785. (1962). Quantity and quality of Industrial Therapy. Lancet, 2, 1375. Walk, A. (1959). On the state of lunacy, 1859-1959. /. Ment. Sci., 105, 879-892. (1961). The history of mental nursing. /. Ment. Sci., 107, 1-17. Walsh, D. (1961). Community Mental Health. /. Irish Med. Assocn., 48,98-104. (1962). Cultural influences in psychiatric illnesses in the Irish. /. Irish Med. Assocn., L. 62-67. (1965). Epidemiology in the Service of Psychiatry. /. Irish Med. Assocn., 48, 285, 98-104. 159 Walsh D, and McCarthy, P. D. (1965). Suicide in Dublin's elderly. Acta, psychiat. scand., 41. Fasc. 227. Waters, M. A. and Northover, J. (1965). Rehabilitated long-stay schizophrenics in the community. Brit. J. Psychiat. ,111, 258-267. Wilson, I. G. H. (1963). Travels in Psychiatry (Presidential address). Brit. J. Psychiat., 109. 169-176. Wing, J. K. (1957). Family care systems in Norway and Holland. Lancet, 2, 884-885. -- -- (1961"). Rehabilitation and resettlement of the mentally ill. /. Soc. M.O.H., 75, 77-84. o (1963). Rehabilitation of psychiatric patients. Brit. J. Psychiat., 109, 635-641. and Giddens, R. G. T. (1959). Industrial Rehabilitation of long-stay schizophrenic patients. Lancet, 2, 505. Bennett, D. H. and Denham, J. (1964). The industrial rehabilitation of long-stay schizophrenic patients. Medical Research Council Memo., 20, 42. London : H.M.S.O. W.F.M.H. (1961). Mental Health in International Perspective. A review made in 1961 by an International and Interprofessional Study Group. London : World Federation for Mental Health. Whitehead, J. A. (1965). A comprehensive psycho-geriatric service. Lancet, 2, 583-586. W.H.O. (1950-1957). Reports of Committee on Addiction-Producing Drugs. Technical Report Series, Nos. 21, 57, 76, 95, 102, 116, 142. (195H. Alcoholism--Technical Report Series, No. 42. (1952). Alcoholism. Second Report. Technical Report Series, No. 48. (1953). The Community Mental Hospital: Technical Report Series, No. 73, (1954). Legislation Affecting Psychiatric Treatment. Technical Report Series, No. 98. (1955). Hospitalisation of Mental Patients. A survey of exisitng legislation, (1956). Expert Committee on Psychiatric Nursing, first report. Technical Report Series, No. 105. o (1957). Juvenile Epilepsy : report of a study group. Technical Report Series, No. 130. (1957). Treatment and Care of Drug Addicts. Technical Report Series, No. 131. (1959). Mental health problems of ageing and the aged. Technical Report Series, No. 111. (1959). Social Psychiatry and Community Attitudes. Technical Report Series, No. 177. (1960). Epidemiology of Mental Disorders. Technical Report Series, No. 185. (1961). Programme Development in the Mental Health Field. Technical Report Series, No. 223. (1961). Teaching of Psychiatry and Mental Health. Public Health Papers, No. 9. (1961). The Undergraduate Teaching of Psychiatry and Mental Health Promotion. Technical Report Series, No. 208. (1961). The use and training of Auxiliary Personnel in Medicine, Nursing, Midwifery and Sanitation. Technical Report Series, No. 212. (1962). Mental Health and the Family. Report of Athens Seminar. (1962). Internationally Acceptable minimum standards of Medical Education. Technical Report Series, No. 239. (1962). The Role of Public Health Officers and General Practitioners in Mental Health Care. Technical Report Series, No. 235. (1963). Training of Psychiatrists. Technical Report Series, No. 252. (1964). In-patient Psychiatric Treatment of Children. Report of Frankfort Seminar. (1964). General Practice. Technical Report Series, No. 267. Woodmansey, A. L. (1965). The Health Visitor's role in preventive psychiatry. Medical Officer, 113, 339-341. Wortis, J. (1956). A psychiatric study tour of the U.S.S.R. J. Ment. Sci., 102, 119-156. Yde, A. and Venge I. (1958). The treatment of alcoholics. Danish Med. Bulletin, 6,210-212. Copenhagen : Olaf Mollers. 159 Walsh D, and McCarthy, P. D. (1965). Suicide in Dublin's elderly. Acta, psychiat. scand., 41. Fasc. 227. Waters, M. A. and Northover, J. (1965). Rehabilitated long-stay schizophrenics in the community. Brit. J. Psychiat. ,111, 258-267. Wilson, I. G. H. (1963). Travels in Psychiatry (Presidential address). Brit. J. Psychiat., 109. 169-176. Wing, J. K. (1957). Family care systems in Norway and Holland. Lancet, 2, 884-885. -- -- (1961"). Rehabilitation and resettlement of the mentally ill. /. Soc. M.O.H., 75, 77-84. o (1963). Rehabilitation of psychiatric patients. Brit. J. Psychiat., 109, 635-641. and Giddens, R. G. T. (1959). Industrial Rehabilitation of long-stay schizophrenic patients. Lancet, 2, 505. Bennett, D. H. and Denham, J. (1964). The industrial rehabilitation of long-stay schizophrenic patients. Medical Research Council Memo., 20, 42. London : H.M.S.O. W.F.M.H. (1961). Mental Health in International Perspective. A review made in 1961 by an International and Interprofessional Study Group. London : World Federation for Mental Health. Whitehead, J. A. (1965). A comprehensive psycho-geriatric service. Lancet, 2, 583-586. W.H.O. (1950-1957). Reports of Committee on Addiction-Producing Drugs. Technical Report Series, Nos. 21, 57, 76, 95, 102, 116, 142. (195H. Alcoholism--Technical Report Series, No. 42. (1952). Alcoholism. Second Report. Technical Report Series, No. 48. (1953). The Community Mental Hospital: Technical Report Series, No. 73, (1954). Legislation Affecting Psychiatric Treatment. Technical Report Series, No. 98. (1955). Hospitalisation of Mental Patients. A survey of exisitng legislation, (1956). Expert Committee on Psychiatric Nursing, first report. Technical Report Series, No. 105. o (1957). Juvenile Epilepsy : report of a study group. Technical Report Series, No. 130. (1957). Treatment and Care of Drug Addicts. Technical Report Series, No. 131. (1959). Mental health problems of ageing and the aged. Technical Report Series, No. 111. (1959). Social Psychiatry and Community Attitudes. Technical Report Series, No. 177. (1960). Epidemiology of Mental Disorders. Technical Report Series, No. 185. (1961). Programme Development in the Mental Health Field. Technical Report Series, No. 223. (1961). Teaching of Psychiatry and Mental Health. Public Health Papers, No. 9. (1961). The Undergraduate Teaching of Psychiatry and Mental Health Promotion. Technical Report Series, No. 208. (1961). The use and training of Auxiliary Personnel in Medicine, Nursing, Midwifery and Sanitation. Technical Report Series, No. 212. (1962). Mental Health and the Family. Report of Athens Seminar. (1962). Internationally Acceptable minimum standards of Medical Education. Technical Report Series, No. 239. (1962). The Role of Public Health Officers and General Practitioners in Mental Health Care. Technical Report Series, No. 235. (1963). Training of Psychiatrists. Technical Report Series, No. 252. (1964). In-patient Psychiatric Treatment of Children. Report of Frankfort Seminar. (1964). General Practice. Technical Report Series, No. 267. Woodmansey, A. L. (1965). The Health Visitor's role in preventive psychiatry. Medical Officer, 113, 339-341. Wortis, J. (1956). A psychiatric study tour of the U.S.S.R. J. Ment. Sci., 102, 119-156. Yde, A. and Venge I. (1958). The treatment of alcoholics. Danish Med. Bulletin, 6,210-212. Copenhagen : Olaf Mollers. 160 APPENDIX E. List of Health Authorities Administering Mental Hospitals. i Health Authority (County Council unless otherwise stated) Louth Galway-Roscommon Mental Health Board Carlow-Kildare Mental Health Board Mayo District Served 1961 Population Hospital Number of patients on Register on 31/12/1965 356 1,575 404 390 County Louth Counties Galway and Roscommon Counties Carlow and Kildare Co. Mayo 67,378 149,887 59,217 33,342 64,420 123,330 123,822 330,443 Ardee Ballinasloe .. Castlerea .. Carlow Castlebar Clonmel Our Lady's Hospital, Cork *St. Raphael's Hospital, Youghal Ennis Enniscorthy .. 1,022 698 Tipyerary Mental Co. Tipperary Health Board Cork Cork City and County 2,235 Clare Wexford Dublin Co. Clare Co. Wexford .. Dublin City and County and Co. Wicklow Co. Kilkenny Co. Kerry Co. Donegal Limerick City and County Counties Cavan and Monaghan Counties Longford Meath and Westmeath Counties Laois and Offaly Counties Leitrim and Sligo Waterford City and County Co. Wicklow .. 73,702 83,308 718,332 625 453 3,553 427 830 .. 614 855 .. 749 Grangegorman Ballyowen Portrane Kilkenny Killarney Letterkenny Limerick Monaghan Kilkenny Kerry Donegal Limeiick Cavan-Monaghan Mental Health Board Longford-MeathWestmeath Mental Health Board Laois-Offaly Mental Health Board Lcitrim-Sligo Mental Health Board Waterford Wicklow 61,668 116,458 113,842 133,339 56,594 47,088 30,643 65,122 52,861 45,069 51,533 33,470 53,561 71,439 58,473 Mullingar 988 Portlaois Sligo Waterford Newcastle .. 596 710 504 Nil to be opened at an early date oPatients are not at present admitted directly to this hospital. 160 APPENDIX E. List of Health Authorities Administering Mental Hospitals. i Health Authority (County Council unless otherwise stated) Louth Galway-Roscommon Mental Health Board Carlow-Kildare Mental Health Board Mayo District Served 1961 Population Hospital Number of patients on Register on 31/12/1965 356 1,575 404 390 County Louth Counties Galway and Roscommon Counties Carlow and Kildare Co. Mayo 67,378 149,887 59,217 33,342 64,420 123,330 123,822 330,443 Ardee Ballinasloe .. Castlerea .. Carlow Castlebar Clonmel Our Lady's Hospital, Cork *St. Raphael's Hospital, Youghal Ennis Enniscorthy .. 1,022 698 Tipyerary Mental Co. Tipperary Health Board Cork Cork City and County 2,235 Clare Wexford Dublin Co. Clare Co. Wexford .. Dublin City and County and Co. Wicklow Co. Kilkenny Co. Kerry Co. Donegal Limerick City and County Counties Cavan and Monaghan Counties Longford Meath and Westmeath Counties Laois and Offaly Counties Leitrim and Sligo Waterford City and County Co. Wicklow .. 73,702 83,308 718,332 625 453 3,553 427 830 .. 614 855 .. 749 Grangegorman Ballyowen Portrane Kilkenny Killarney Letterkenny Limerick Monaghan Kilkenny Kerry Donegal Limeiick Cavan-Monaghan Mental Health Board Longford-MeathWestmeath Mental Health Board Laois-Offaly Mental Health Board Lcitrim-Sligo Mental Health Board Waterford Wicklow 61,668 116,458 113,842 133,339 56,594 47,088 30,643 65,122 52,861 45,069 51,533 33,470 53,561 71,439 58,473 Mullingar 988 Portlaois Sligo Waterford Newcastle .. 596 710 504 Nil to be opened at an early date oPatients are not at present admitted directly to this hospital. 161 APPENDIX F Approved Staffing Establishments--District Mental Hospitals 1/6/1966 oResident Medical Superintendent (On 1/6/1966, 20 were filled by permanent officers and 1 by a Senior Assistant Medical Officer in an acting capacity) Senior Assistant Medical Officer .. (On 1/6/1966, 29 were filled by permanent officers,7 by Assistant Medical Officers in an acting capacity and 6 posts were vacant) Assistant Medical Officer (On 1/6/1966, 30 were filled by permanent officers, 32 by temporary officers and 6 were vacant) House Physician (Training posts normally held for short periods--all were filled on 1/6/1966) Matron Deputy Matron Head Nurse Deputy Head Nurse 21 Head Night Nurse (M) .. . 17 ,, ,, (F) . . . 19 Deputy Head Night Nurse (M) . . 18 ,, ,, ,, (F) . . 21 Psychiatric Social Worker 2 Compounder 9 Visiting Dentist . 22 Anaesthetist 4 Charge and Deputy Charge Nurse 510 Ward and Deputy Ward Sister . . 449 General Trained Nurse . 141 Psychiatric Nurse and Trainee 2,795 Physiotherapist 2 Occupational Therapist .. . 11 Visiting Chiropodist . 11 Radiographer . 2 Nurse for Mentally Handicapped 2 Outpatient Nurse 8 Sick Children's Nurse 2 Visiting Psychologist 3 Visiting Ophthalmic Surgeon 2 Visiting Speech Therapist ... 2 42 68 12 23 28 20 25 oThe title Resident Medical Superintendent includes : 1 Medical Superintendent, St. Ita's Hospital, Portrane. 1 Medical Superintendent, St. Loman's Hospital, Ballyowen. 161 APPENDIX F Approved Staffing Establishments--District Mental Hospitals 1/6/1966 oResident Medical Superintendent (On 1/6/1966, 20 were filled by permanent officers and 1 by a Senior Assistant Medical Officer in an acting capacity) Senior Assistant Medical Officer .. (On 1/6/1966, 29 were filled by permanent officers,7 by Assistant Medical Officers in an acting capacity and 6 posts were vacant) Assistant Medical Officer (On 1/6/1966, 30 were filled by permanent officers, 32 by temporary officers and 6 were vacant) House Physician (Training posts normally held for short periods--all were filled on 1/6/1966) Matron Deputy Matron Head Nurse Deputy Head Nurse 21 Head Night Nurse (M) .. . 17 ,, ,, (F) . . . 19 Deputy Head Night Nurse (M) . . 18 ,, ,, ,, (F) . . 21 Psychiatric Social Worker 2 Compounder 9 Visiting Dentist . 22 Anaesthetist 4 Charge and Deputy Charge Nurse 510 Ward and Deputy Ward Sister . . 449 General Trained Nurse . 141 Psychiatric Nurse and Trainee 2,795 Physiotherapist 2 Occupational Therapist .. . 11 Visiting Chiropodist . 11 Radiographer . 2 Nurse for Mentally Handicapped 2 Outpatient Nurse 8 Sick Children's Nurse 2 Visiting Psychologist 3 Visiting Ophthalmic Surgeon 2 Visiting Speech Therapist ... 2 42 68 12 23 28 20 25 oThe title Resident Medical Superintendent includes : 1 Medical Superintendent, St. Ita's Hospital, Portrane. 1 Medical Superintendent, St. Loman's Hospital, Ballyowen. DISTRICT MENTAL HOSPITALS--Out-Patient Clinics Year ended 31tf March, 1965 APPENDIX G District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total St. Brigid's Hospital, Ardee, County Louth. 67,378 (i) (ii) (iii) (iv) (v) (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) St. Patrick's Hospital, Castlerea, County Roscommon. 59,217 (i) (ii) (iii) (iv) (v) St. Joseph's, Ardee Drogheda Dundalk Carlingford Dundalk (Children's) Portiuncula Hospital Bealadangan Clifden St. Brigid's Hospital Ballinasloe. Regional Hospital, Galway. Shantalla, Galway Tuam Gort Portumna Castlerea Boyle Roscommon Strokestown Ballaghaderreen Weekly Weekly Weekly Alternate Weeks Weekly Twice monthly Monthly Monthly Monday-Friday (5 days weekly). Weekly Weekly Weekly Twice monthly Twice monthly Daily Fortnightly Fortnightly Fortnightly Fortnightly 123 196 302 42 50 713 St. Brigid's Hospital, Ballinasloe, County Galway. 149,887 70 Miles 90 ,, 109 19 31 108 116 240 140 57 54 874 684 563 599 447 299 2,592 1,172 883 904 968 507 4,434 259 60 96 390 204 924 504 195 154 2,786 531 1,116 1,752 120 264 3,783 Number of Attendances Grand Total 15 Miles 13 ,, 27 ,, 13 ,, -- 40 40 33 34 20 ,, ,, ,, ,, ,, __ 19 Miles 19 ,, 18 ,, 12 ,, DISTRICT MENTAL HOSPITALS--Out-Patient Clinics Year ended 31tf March, 1965 APPENDIX G District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total St. Brigid's Hospital, Ardee, County Louth. 67,378 (i) (ii) (iii) (iv) (v) (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) St. Patrick's Hospital, Castlerea, County Roscommon. 59,217 (i) (ii) (iii) (iv) (v) St. Joseph's, Ardee Drogheda Dundalk Carlingford Dundalk (Children's) Portiuncula Hospital Bealadangan Clifden St. Brigid's Hospital Ballinasloe. Regional Hospital, Galway. Shantalla, Galway Tuam Gort Portumna Castlerea Boyle Roscommon Strokestown Ballaghaderreen Weekly Weekly Weekly Alternate Weeks Weekly Twice monthly Monthly Monthly Monday-Friday (5 days weekly). Weekly Weekly Weekly Twice monthly Twice monthly Daily Fortnightly Fortnightly Fortnightly Fortnightly 123 196 302 42 50 713 St. Brigid's Hospital, Ballinasloe, County Galway. 149,887 70 Miles 90 ,, 109 19 31 108 116 240 140 57 54 874 684 563 599 447 299 2,592 1,172 883 904 968 507 4,434 259 60 96 390 204 924 504 195 154 2,786 531 1,116 1,752 120 264 3,783 Number of Attendances Grand Total 15 Miles 13 ,, 27 ,, 13 ,, -- 40 40 33 34 20 ,, ,, ,, ,, ,, __ 19 Miles 19 ,, 18 ,, 12 ,, District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total Number of Attendances Grand Total 481 346 297 194 294 293 914 349 St. Dympna's Hospital, Carlow Carlow 33,342 Kildare 64,420 (Carlow/Kildare Mental Health Board). 97,762 (i) St. Vincent's, Athy (ii) District Hospital, Muinebeag. (iii) Carbury (iv) Bonis (v) Monasterevan (vi) Carlow (vii) County Hospital, Naas (viii) Tullow Hospital (i) (ii) (iii) (iv) (v) (vi) (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) Castlebar Ballina Belmullet Claremorris Swinford Achill Tipperary Carrick-on-Suir Thurles Cashel Clogheen Clonmel Nenagh Roscrea Weekly Twice monthly Twice monthly Twice monthly Twice monthly Twice monthly Weekly Twice monthly Twice monthly Twice monthly Monthly Monthly Monthly Monthly Twice monthly Monthly Monthly Monthly Monthly Weekly Twice monthly Monthly 12 Miles 10 ,, 44 18 24 31 8 ,, ,, ,, 135 94 119 51 99 77 318 82 975 118 152 137 111 82 95 695 78 67 293 53 23 150 190 22 876 -- ,, ,, 3,168 356 515 345 395 294 462 2,367 304 169 320 147 115 503 462 116 2,136 St. Mary's Hospital, Castlebar, County Mayo. 123,330 22 Miles 48 ,, 17 ,, 18 ,, 32 ,, 24 Miles 13 ,, 28 ,, 15 ,, 16 ,, 50 49 St. Luke's Hospital Clonmel, County Tipperary. 123,822 -- ,, ,, District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total Number of Attendances Grand Total 481 346 297 194 294 293 914 349 St. Dympna's Hospital, Carlow Carlow 33,342 Kildare 64,420 (Carlow/Kildare Mental Health Board). 97,762 (i) St. Vincent's, Athy (ii) District Hospital, Muinebeag. (iii) Carbury (iv) Bonis (v) Monasterevan (vi) Carlow (vii) County Hospital, Naas (viii) Tullow Hospital (i) (ii) (iii) (iv) (v) (vi) (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) Castlebar Ballina Belmullet Claremorris Swinford Achill Tipperary Carrick-on-Suir Thurles Cashel Clogheen Clonmel Nenagh Roscrea Weekly Twice monthly Twice monthly Twice monthly Twice monthly Twice monthly Weekly Twice monthly Twice monthly Twice monthly Monthly Monthly Monthly Monthly Twice monthly Monthly Monthly Monthly Monthly Weekly Twice monthly Monthly 12 Miles 10 ,, 44 18 24 31 8 ,, ,, ,, 135 94 119 51 99 77 318 82 975 118 152 137 111 82 95 695 78 67 293 53 23 150 190 22 876 -- ,, ,, 3,168 356 515 345 395 294 462 2,367 304 169 320 147 115 503 462 116 2,136 St. Mary's Hospital, Castlebar, County Mayo. 123,330 22 Miles 48 ,, 17 ,, 18 ,, 32 ,, 24 Miles 13 ,, 28 ,, 15 ,, 16 ,, 50 49 St. Luke's Hospital Clonmel, County Tipperary. 123,822 -- ,, ,, Popula- Approximate District Mental Hospital tion Location of Clinic Frequency distance from Number of Number of served Hospital Patients Attendances Grand Grand Total Total OurLady's Hospital, Cork 330,443 St. Anne's, Cork Daily 805 5,806 and St. Raphael's, (ii) Mallow 22 76 275 Youghal, County Cork. Clonakilty 33 32 117 (iv) Youghal 31 47 141 Fermoy 23 78 342 (vi) Bantry 56 45 123 (vii) Castletownbere 83 26 74 Macroom 23 69 221 (ix) Bandon 20 51 224 Kanturk 35 72 309 (xi) Dunmanway 37 59 145 (xii) Skibbereen 53 72 230 Midleton 14 65 176 (xiv) North Infirmary, Cork Weekly 2 212 824 1,709 9,007 OurLady's Hospital,Ennis, 73,702 Kilrush Twice 27 367 749 County Clare. (ii) Bindon Street, Ennis 134 208 Raheen 23 100 208 iv Ennistymon 17 139 218 Our Lady's Hospital, Three times weekly 209 627 Ennis 949 2,010 St. Senan's Hospital, 83,308 Enniscorthy Weekly 241 1,370 Enniscorthy, County (ii) Wexford Weekly 15 Miles 351 1,271 Wexford. 592 2,641 Popula- Approximate District Mental Hospital tion Location of Clinic Frequency distance from Number of Number of served Hospital Patients Attendances Grand Grand Total Total OurLady's Hospital, Cork 330,443 St. Anne's, Cork Daily 805 5,806 and St. Raphael's, (ii) Mallow 22 76 275 Youghal, County Cork. Clonakilty 33 32 117 (iv) Youghal 31 47 141 Fermoy 23 78 342 (vi) Bantry 56 45 123 (vii) Castletownbere 83 26 74 Macroom 23 69 221 (ix) Bandon 20 51 224 Kanturk 35 72 309 (xi) Dunmanway 37 59 145 (xii) Skibbereen 53 72 230 Midleton 14 65 176 (xiv) North Infirmary, Cork Weekly 2 212 824 1,709 9,007 OurLady's Hospital,Ennis, 73,702 Kilrush Twice 27 367 749 County Clare. (ii) Bindon Street, Ennis 134 208 Raheen 23 100 208 iv Ennistymon 17 139 218 Our Lady's Hospital, Three times weekly 209 627 Ennis 949 2,010 St. Senan's Hospital, 83,308 Enniscorthy Weekly 241 1,370 Enniscorthy, County (ii) Wexford Weekly 15 Miles 351 1,271 Wexford. 592 2,641 District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total Number of Attendances Grand Total 9,557 1,517 1,083 590 1,082 2,970 299 4 St. Brendan's Hospital, Grangegorman, Dublin. Dublin 718,332 *Wicklow 58,473 776,805 (i) St. Brendan's Hospital, Grangegorman. (ii) Crumlin (iii) Mercer's Hospital (iv) Dun Laoghaire (v) Ballyfermot (vi) St. Loman's (vii) Finglas (viii) Killester (opened 24/2/65) (ix) Balbriggan (i) Kilkenny County Health Clinic. (ii) Castlecomer District Hospital. (iii) Mullinavat (iv) Rosbercon (v) Thomastown (vi) Callan (vii) St. Canice's Hospital, Kilkenny. (i) (ii) (iii) (iv) (v) (vi) Tralee Listowel Killarney Dingle Kenmare Cahirciveen 31 per fortnight 2 weekly 2 weekly 2 weekly 2 weekly 1 weekly 2 weekly 2 monthly 2 monthly Twice weekly Twice monthly Twice monthly Twice monthly Twice monthly Twice monthly As required All in the greater Dublin area. 1,148 175 195 82 786 2,636 123 4 51 484 57 36 44 35 15 85 756 5,200 20 Miles 279 1,050 63 61 73 127 56 696 17,381 St. Canice's Kilkenny. Hospital, 61,668 -- 12 Miles 22 27 11 10 ,, ,, ,, ,, 2,126 2,395 1,510 1,134 895 598 1,059 St. Finan's Hospital, Killarney, County Kerry. 116,458 Three per week Weekly Weekly Weekly Weekly Weekly 20 Miles 37 ,, 41 21 39 -- ,, ,, ,, 339 242 173 109 117 231 1,211 - 7,591 *On 31st March, 1965, Wicklow patients were still catered for in Dublin. District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total Number of Attendances Grand Total 9,557 1,517 1,083 590 1,082 2,970 299 4 St. Brendan's Hospital, Grangegorman, Dublin. Dublin 718,332 *Wicklow 58,473 776,805 (i) St. Brendan's Hospital, Grangegorman. (ii) Crumlin (iii) Mercer's Hospital (iv) Dun Laoghaire (v) Ballyfermot (vi) St. Loman's (vii) Finglas (viii) Killester (opened 24/2/65) (ix) Balbriggan (i) Kilkenny County Health Clinic. (ii) Castlecomer District Hospital. (iii) Mullinavat (iv) Rosbercon (v) Thomastown (vi) Callan (vii) St. Canice's Hospital, Kilkenny. (i) (ii) (iii) (iv) (v) (vi) Tralee Listowel Killarney Dingle Kenmare Cahirciveen 31 per fortnight 2 weekly 2 weekly 2 weekly 2 weekly 1 weekly 2 weekly 2 monthly 2 monthly Twice weekly Twice monthly Twice monthly Twice monthly Twice monthly Twice monthly As required All in the greater Dublin area. 1,148 175 195 82 786 2,636 123 4 51 484 57 36 44 35 15 85 756 5,200 20 Miles 279 1,050 63 61 73 127 56 696 17,381 St. Canice's Kilkenny. Hospital, 61,668 -- 12 Miles 22 27 11 10 ,, ,, ,, ,, 2,126 2,395 1,510 1,134 895 598 1,059 St. Finan's Hospital, Killarney, County Kerry. 116,458 Three per week Weekly Weekly Weekly Weekly Weekly 20 Miles 37 ,, 41 21 39 -- ,, ,, ,, 339 242 173 109 117 231 1,211 - 7,591 *On 31st March, 1965, Wicklow patients were still catered for in Dublin. District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total Number of Attendances Grand Total 506 223 322 242 87 119 149 141 132 151 217 329 388 822 1,751 89 123 757 204 611 1,442 118 909 St. Conal's Hospital, Letterkenny, County Donegal. 113,842 (i) Letterkenny County Hospital (ii) Buncrana (iii) Carndonagh (iv) Dungloe (v) Donegal (vi) Ballyshannon (vii) Glenties (viii) Killybegs (ix) Milford (x) Falcarragh (i) (ii) (iii) (iv) (v) (vi) (vii) Foynes Kilmallock Hospital Newcastlewest Limerick Croom Doon Twice monthly Twice monthly Twice monthly Twice monthly Monthly Monthly Monthly Monthly Monthly Monthly Twice monthly Twice monthly Twice monthly Twice monthly Weekly Twice monthly Twice monthly Twice monthly Twice monthly Twice monthly Weekly Monthly Weekly by arrangement 29 Miles 48 ,, 32 ,, 32 ,, 47 ,, 28 ,, 50 ,, 12 ,, 26 ,, 16 Miles 21 ,, 17 ,, 26 ,, 12 14 163 62 95 79 38 52 53 48 42 49 201 271 366 755 1,567 78 108 133 53 101 273 43 166 142 911 681 o 2,072 St. Joseph's Limerick. Hospital, 133,339 -- ,, ,, 3,346 3,719 St. Davnet's Monaghan. Hospital, 103,682 Cavan 56,594 Monaghan 47,088 (i) Bailieboro (ii) Ballyjamesduff (iii) Carrickmacross (iv) Cavan (v) Clones (vi) Monaghan County Hospital, (vii) St. Davnet's Hospital 30 Miles 42 ,, 26 ,, 30 ,, 13 ,, -- 910 4,951 District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total Number of Attendances Grand Total 506 223 322 242 87 119 149 141 132 151 217 329 388 822 1,751 89 123 757 204 611 1,442 118 909 St. Conal's Hospital, Letterkenny, County Donegal. 113,842 (i) Letterkenny County Hospital (ii) Buncrana (iii) Carndonagh (iv) Dungloe (v) Donegal (vi) Ballyshannon (vii) Glenties (viii) Killybegs (ix) Milford (x) Falcarragh (i) (ii) (iii) (iv) (v) (vi) (vii) Foynes Kilmallock Hospital Newcastlewest Limerick Croom Doon Twice monthly Twice monthly Twice monthly Twice monthly Monthly Monthly Monthly Monthly Monthly Monthly Twice monthly Twice monthly Twice monthly Twice monthly Weekly Twice monthly Twice monthly Twice monthly Twice monthly Twice monthly Weekly Monthly Weekly by arrangement 29 Miles 48 ,, 32 ,, 32 ,, 47 ,, 28 ,, 50 ,, 12 ,, 26 ,, 16 Miles 21 ,, 17 ,, 26 ,, 12 14 163 62 95 79 38 52 53 48 42 49 201 271 366 755 1,567 78 108 133 53 101 273 43 166 142 911 681 o 2,072 St. Joseph's Limerick. Hospital, 133,339 -- ,, ,, 3,346 3,719 St. Davnet's Monaghan. Hospital, 103,682 Cavan 56,594 Monaghan 47,088 (i) Bailieboro (ii) Ballyjamesduff (iii) Carrickmacross (iv) Cavan (v) Clones (vi) Monaghan County Hospital, (vii) St. Davnet's Hospital 30 Miles 42 ,, 26 ,, 30 ,, 13 ,, -- 910 4,951 District Mental Hospital Population served Location of Clinic Frequency Approximate distance from Hospital Number of Patients Grand Total Number of Attendances Grand Total 624 772 972 169 503 116 3 St. Loman's Hospital, Mullingar, County Westmeath. Longford 30,643 Meath 65,122 Westmeath 52,861 148,626 (i) Longford (ii) Mullingar (iii) Navan (iv) Granard (v) Athlone (vi) Oldcastle *(vii) St. Loman's Hospital, Mullingar Weekly Weekly Weekly Twice monthly Weekly Twice monthly Weekly 27 Miles 36 26 29 23 ,, ,, ,, ,, 181 203 261 47 119 32 3 846 3,159 639 347 165 107 804 St. Fintan's Hospital, Portlaoise (Laois). Laois 45,069 Oflaly 51,533 96,602 (i) Tullamore (ii) Portlaoise (County Clinic), (iii) Birr (iv) Edenderry (v) St. Fintan's Hospital, Portlaoise. Twice monthly Twice monthly Monthly Monthly Daily 22 Miles 37 28 ,, ,, 76 65 79 37 57 314 2,062 St. Columba's Hospital, Sligo. Sligo 53,561 Leitrim 33,470 87,031 (i) (ii) (iii) (iv) Kinlough Ballinamore Cliffoney Carrick-on-Shannon, Leitrim. Monthly Monthly Monthly Monthly 30 Miles 40 ,, 14 ,,. 35 ,, 29 28 17 18 98 109 84 86 *Op<> INDEX. NOTE--REFERENCES ARE TO PARAGRAPHS Absence with permission, 212 Acknowledgements, 2, 4, 213 Activation and Group Leadership, need for training in, 167 Addicts, Drug, services for, 113 to 115 Administration-- psychiatric services, existing pattern, 22 to 29 psychiatric services, proposed changes, 186 to 199 Adolescents, services for, 98 to 102,138, 140 After Care, 73, 76, 79, 81, 82, 84, 85 Aged patients, services for, 103 to 106 Alcoholics Anonymous, 111 Alcoholics, services for, 107 to 112 Area boundaries, 196 Arrangement of Report, 5 Assessment Geriatric Units, need for, 104 Autistic Children, 88 Boarding Out--see Family Care Bord Altranais, nurse training, 160 to 167 Building Control, 198 Buildings--see mental hospitals Career guidance, 142 Central Mental Hospital, Dundrum, 9, 10,126, 129, 131, 199 Children, services for, 88 to 97, 138, 140 Chaplains Mental Hospitals, 173 to 175 Civics, training in, 141 Clergy, role of, in a programme of public education, 180 Clinics, Out-patient, District and Regional, 24, 29, 73, 90, 92 Clubs, for psychiatric patients, 85 Commissions and Committees, Reports of former, 9 Community Care, 16, 72 to 86 Compulsory admission and detention of patients, 203 Courts-- Adolescents appearing before, 102 Children appearing before, 96 Persons appearing before, 132 Criminal Lunatics, services for, 119 to 127 Custodial care, 14 Day Hospitals, 24, 75 Delinquency, 102 Designation of Mental Hospitals, 209 Detention procedures, psychiatric patients, 201, 203, 204 Disabled Persons Maintenance Allowance, 86 District Mental Hospitals--see Mental Hospitals Domiciliary Nursing, 164 Drug Addicts, services for, 113 to 115 Education, professional and general public, 152 to 185 Epileptics, services for, 116 to 118 Family Care, 78 to 80, 94, 210 Farms, Hospital, 197 Financial Assistance-- Clubs for patients, 85 Ex-patients, 86 Research projects, 112, 151 Voluntary Agencies, 84 178 o>> INDEX. NOTE--REFERENCES ARE TO PARAGRAPHS Absence with permission, 212 Acknowledgements, 2, 4, 213 Activation and Group Leadership, need for training in, 167 Addicts, Drug, services for, 113 to 115 Administration-- psychiatric services, existing pattern, 22 to 29 psychiatric services, proposed changes, 186 to 199 Adolescents, services for, 98 to 102,138, 140 After Care, 73, 76, 79, 81, 82, 84, 85 Aged patients, services for, 103 to 106 Alcoholics Anonymous, 111 Alcoholics, services for, 107 to 112 Area boundaries, 196 Arrangement of Report, 5 Assessment Geriatric Units, need for, 104 Autistic Children, 88 Boarding Out--see Family Care Bord Altranais, nurse training, 160 to 167 Building Control, 198 Buildings--see mental hospitals Career guidance, 142 Central Mental Hospital, Dundrum, 9, 10,126, 129, 131, 199 Children, services for, 88 to 97, 138, 140 Chaplains Mental Hospitals, 173 to 175 Civics, training in, 141 Clergy, role of, in a programme of public education, 180 Clinics, Out-patient, District and Regional, 24, 29, 73, 90, 92 Clubs, for psychiatric patients, 85 Commissions and Committees, Reports of former, 9 Community Care, 16, 72 to 86 Compulsory admission and detention of patients, 203 Courts-- Adolescents appearing before, 102 Children appearing before, 96 Persons appearing before, 132 Criminal Lunatics, services for, 119 to 127 Custodial care, 14 Day Hospitals, 24, 75 Delinquency, 102 Designation of Mental Hospitals, 209 Detention procedures, psychiatric patients, 201, 203, 204 Disabled Persons Maintenance Allowance, 86 District Mental Hospitals--see Mental Hospitals Domiciliary Nursing, 164 Drug Addicts, services for, 113 to 115 Education, professional and general public, 152 to 185 Epileptics, services for, 116 to 118 Family Care, 78 to 80, 94, 210 Farms, Hospital, 197 Financial Assistance-- Clubs for patients, 85 Ex-patients, 86 Research projects, 112, 151 Voluntary Agencies, 84 178 179 Garda Siochana, role of, programme of public education, 181 General Hospitals-- Clinics, 29 Short-term psychiatric units in or associated with, 32 to 49 General Practitioners-- employment of, in mental hospitals, 51, 82 role of, 82 treatment of alcoholics by, 109 Geriatric Patients, 103 to 106 Group Leadership and Activation, Importance of, 167 Health Authorities, services provided by, 22, 29, 150 Hospital Accommodation--see mental hospitals Hospital Committees, 195 Hospital Farms, 197 Hostels, 81 Improper detention of patients, 204 Industrial Schools, children in, 97 Industrial Therapy, 57 Informal admission of patients, 202 In-patient care--see mental hospitals Integration of psychiatry and general medicine, 18, 189 Juvenile Delinquency, 102 Legal Profession, role of, programme of public education, 182 Legislation, 10, 200 to 212 compulsory admission and detention, 203 improper detention, remedies for, 204 informal admission of patients, 202 reception and detention of patients, 201 registration of residential centres for the mentally ill, 205, 206 Library Facilities, 166 Marriage Guidance Courses, need for, 185 Maternity patients, need for providing psychiatric services, 143 Medical Education, Organisation of in Ireland, 153 to 155 Medical Research Council, 150 Medico-Social Research Board, 150 Membership of Commission, Appendix A Mental Health Promotion, 83,136 to 146 Mental Hospitals-- administrative and clerical staff, 191 area boundaries, 196 auxiliary mental hospitals, 10 building control, need for ,198 central mental hospital, 9, 10,126,129, 131 chaplains, 173 to 175 committees, 64, 195 day and night hospitals, 24, 75 designation of, 209 development of private, 7 development of public, 6 district, accommodation and facilities in, 23, 67 district, future use of, 67 farms, 197 long term in-patient care, 50 to 67 medical staff structure, 190 number of in-patients, 19, 30, 40, 66 nursing staff, flexibility in the use of, 192 nursing staff structure, 193 private, accommodation and facilities in, 26, 27, Appendix H. private, and homes, future use of, 68 to 71 provision for short-term care, 43 to 49 short-term psychiatric units in general hospitals, 32 to 49 staffing of, 25, 28, Appendix F, J. 179 Garda Siochana, role of, programme of public education, 181 General Hospitals-- Clinics, 29 Short-term psychiatric units in or associated with, 32 to 49 General Practitioners-- employment of, in mental hospitals, 51, 82 role of, 82 treatment of alcoholics by, 109 Geriatric Patients, 103 to 106 Group Leadership and Activation, Importance of, 167 Health Authorities, services provided by, 22, 29, 150 Hospital Accommodation--see mental hospitals Hospital Committees, 195 Hospital Farms, 197 Hostels, 81 Improper detention of patients, 204 Industrial Schools, children in, 97 Industrial Therapy, 57 Informal admission of patients, 202 In-patient care--see mental hospitals Integration of psychiatry and general medicine, 18, 189 Juvenile Delinquency, 102 Legal Profession, role of, programme of public education, 182 Legislation, 10, 200 to 212 compulsory admission and detention, 203 improper detention, remedies for, 204 informal admission of patients, 202 reception and detention of patients, 201 registration of residential centres for the mentally ill, 205, 206 Library Facilities, 166 Marriage Guidance Courses, need for, 185 Maternity patients, need for providing psychiatric services, 143 Medical Education, Organisation of in Ireland, 153 to 155 Medical Research Council, 150 Medico-Social Research Board, 150 Membership of Commission, Appendix A Mental Health Promotion, 83,136 to 146 Mental Hospitals-- administrative and clerical staff, 191 area boundaries, 196 auxiliary mental hospitals, 10 building control, need for ,198 central mental hospital, 9, 10,126,129, 131 chaplains, 173 to 175 committees, 64, 195 day and night hospitals, 24, 75 designation of, 209 development of private, 7 development of public, 6 district, accommodation and facilities in, 23, 67 district, future use of, 67 farms, 197 long term in-patient care, 50 to 67 medical staff structure, 190 number of in-patients, 19, 30, 40, 66 nursing staff, flexibility in the use of, 192 nursing staff structure, 193 private, accommodation and facilities in, 26, 27, Appendix H. private, and homes, future use of, 68 to 71 provision for short-term care, 43 to 49 short-term psychiatric units in general hospitals, 32 to 49 staffing of, 25, 28, Appendix F, J. 180 Mental Illness-- ancient times, 11 change of attitude, 12 custodial care, 14 in-patient care--see Mental Hospitals "moral" treatment, 13,14 prevalence of, 8, 20, 89 preventive services, 135 to 146 recent times, 15 "Moral" Treatment of Mental illness, 13,14 National Advisory Council, 151, 187 National Council on Alcoholism, 111 National Organisation for Rehabilitation, 142,172 National Voluntary Organisation, 188 Night Hospitals, 24 Non-Nursing Duties, employment of nurses on, 194 Nursing, domiciliary, 164 Nursing Homes, 69, 71, 206 Nursing Staff, flexibility in the use of, 192 structure of, 193 training, 146 to 151 Occupational Therapy, 53 Occupational Therapists, need for, 171 training facilities in Ireland, 172 Payment for work, 59 Personnel Training, 152 to 185 Placement Services, 61 Post-graduate Medical Education, organisation of in Ireland, 155 Press, role of, in a programme of public education, 184 Prevalence Rates, 40, 66, 89,108,113,116 Preventive Services, 135 to 146 Prisoners, need for psychiatric services for, 127 Private Mental Hospitals--see Mental Hospitals Procedure of Commission, 3 Professional Workers in health fields, role of, in programme of public education, 178 Programme of Public Education, need for, and role of specific groups in, 176 to 184 Psychiatric Nurses, organisation of training in Ireland, 160 recruitment of student, 163 refresher courses for, 165 role of, 159 Psychiatric Services, role of, in a programme of public education, 177 Psychiatric Social Workers, 168-- training facilities in Irealnd, 170 Psychiatric Unit--see Mental Hospitals Psychiatrists, training, 142 Psychologists, role of, 156-- training facilities for, in Ireland, 157,158 Psychopaths, services for, 130 to 131 Public, education of, 176 to 185 Public Health Personnel, role of, 83 Reception procedures, patients, 201 to 204 Refresher courses for psychiatric nurses, 165 Registration of centres for the mentally ill, 205, 206 Rehabilitation services, 52-61, 85 Report, arrangement of, 5 Research, 30, 112, 147-151 Sexual deviates, 133 and 134 Sheltered employment, 60, 207 Social Work, 76, 77 Social Workers, 168 training facilities in Irealnd, 169 Terms of Reference, 1 Training of-- mental hospital chaplains, 174 occupational therapists, 172 180 Mental Illness-- ancient times, 11 change of attitude, 12 custodial care, 14 in-patient care--see Mental Hospitals "moral" treatment, 13,14 prevalence of, 8, 20, 89 preventive services, 135 to 146 recent times, 15 "Moral" Treatment of Mental illness, 13,14 National Advisory Council, 151, 187 National Council on Alcoholism, 111 National Organisation for Rehabilitation, 142,172 National Voluntary Organisation, 188 Night Hospitals, 24 Non-Nursing Duties, employment of nurses on, 194 Nursing, domiciliary, 164 Nursing Homes, 69, 71, 206 Nursing Staff, flexibility in the use of, 192 structure of, 193 training, 146 to 151 Occupational Therapy, 53 Occupational Therapists, need for, 171 training facilities in Ireland, 172 Payment for work, 59 Personnel Training, 152 to 185 Placement Services, 61 Post-graduate Medical Education, organisation of in Ireland, 155 Press, role of, in a programme of public education, 184 Prevalence Rates, 40, 66, 89,108,113,116 Preventive Services, 135 to 146 Prisoners, need for psychiatric services for, 127 Private Mental Hospitals--see Mental Hospitals Procedure of Commission, 3 Professional Workers in health fields, role of, in programme of public education, 178 Programme of Public Education, need for, and role of specific groups in, 176 to 184 Psychiatric Nurses, organisation of training in Ireland, 160 recruitment of student, 163 refresher courses for, 165 role of, 159 Psychiatric Services, role of, in a programme of public education, 177 Psychiatric Social Workers, 168-- training facilities in Irealnd, 170 Psychiatric Unit--see Mental Hospitals Psychiatrists, training, 142 Psychologists, role of, 156-- training facilities for, in Ireland, 157,158 Psychopaths, services for, 130 to 131 Public, education of, 176 to 185 Public Health Personnel, role of, 83 Reception procedures, patients, 201 to 204 Refresher courses for psychiatric nurses, 165 Registration of centres for the mentally ill, 205, 206 Rehabilitation services, 52-61, 85 Report, arrangement of, 5 Research, 30, 112, 147-151 Sexual deviates, 133 and 134 Sheltered employment, 60, 207 Social Work, 76, 77 Social Workers, 168 training facilities in Irealnd, 169 Terms of Reference, 1 Training of-- mental hospital chaplains, 174 occupational therapists, 172 181 psychiatric nurses, 160,161,162 psychiatric social workers, 170 social workers, 169 Undergraduate Medical Education, organisation of in Ireland, 154 Violent patients, 128,129 Voluntary Agencies, role of, 84 Vulnerable Adults, 143 Wards of Court, 208 Young Offenders, 96 Youth Organisations, 100,139 Wt --. -- K53483. 2,500. 3/67. C&Co. (1546). SpL 181 psychiatric nurses, 160,161,162 psychiatric social workers, 170 social workers, 169 Undergraduate Medical Education, organisation of in Ireland, 154 Violent patients, 128,129 Voluntary Agencies, role of, 84 Vulnerable Adults, 143 Wards of Court, 208 Young Offenders, 96 Youth Organisations, 100,139 Wt --. -- K53483. 2,500. 3/67. C&Co. (1546). SpL